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December 21, 2009 — Embargoed ContentJAMA 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. ARCHIVES OF DERMATOLOGY NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, December 21, 2009)
ARCHIVES OF SURGERY NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, December 21, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, December 21, 2009)
PLEASE NOTE: Because Archives of Internal Medicine publishes only one issue in December, there will be no Archives or news releases for December 28. 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, December 21, 2009
Twin Study Identifies Factors Associated With Skin Aging
CHICAGO—Smoking, being heavier, not using sunscreen and having had skin cancer appear to be associated with sun damage and aging of skin on the face, according to report based on a study of twins in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. Long-term exposure to the sun causes physical and structural changes to the skin, resulting in photodamage, according to background information in the article. Unlike typical skin aging, which is characterized by the development of fine wrinkles and skin growths, photodamage includes characteristics such as coarsely wrinkled skin, spots of extra pigment or lost pigment and dilated blood vessels on the face. Sun damage also has been associated with the development of cancerous growths. Up to 40 percent of aging-related changes are due to non-genetic factors. To identify some of these environmental factors, Kathryn J. Martires, B.A., of Case Western Reserve School of Medicine, Cleveland, and colleagues studied 65 pairs of twins attending the 2002 annual Twin Days Festival in Twinsburg, Ohio. A total of 130 individuals completed surveys collecting information about skin type, history of skin cancer, smoking and drinking habits and weight. Clinicians assigned each participant a photodamage score, graded by such characteristics as wrinkling and change in pigmentation. Photodamage scores were highly correlated among both monozygotic (identical) and dizygotic (fraternal) twins. Other factors associated with higher levels of photodamage included a history of skin cancer, heavier weight and smoking, whereas alcohol consumption was associated with lower photodamage scores.
"The Twins Days Festival provides a rare opportunity to study a large number of twin pairs to control for genetic susceptibility. Among the most important results is that a history of skin cancer and photodamage are highly associated in a population that shares genetic commonalities," the authors conclude. "The relationships found between smoking, weight, sunscreen use, skin cancer and photodamage in these twin pairs may help to motivate the reduction of risky behaviors."
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, December 21, 2009
Trends in Melanoma Incidence and Stage at Diagnosis Vary by Racial and Ethnic Group
CHICAGO—White and Hispanic individuals are being diagnosed with melanoma more frequently in recent years, whereas Hispanic and black patients continue to have advanced skin cancer at diagnosis, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. Nationwide, the incidence (rate of new cases diagnosed) of melanoma increased 2.4 percent per year in the last decade, according to background information in the article. "Research and public education efforts have focused on melanoma prevention in white populations because of their higher risk of developing melanoma," the authors write. "Improved secondary prevention measures with earlier detection of thin (early-stage) melanoma likely account for the improved survival among whites from 68 percent in the early 1970s to 92 percent in recent years. Such advances, however, have not occurred in other racial and ethnic groups in the United States." Shasa Hu, M.D., of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, and colleagues analyzed data extracted from the Florida Cancer Data System, a state-wide, population-based cancer incidence registry. Of 41,072 cases of melanoma diagnosed from 1990 to 2004, 39,670 were diagnosed in white non-Hispanic individuals, 1,148 in white Hispanics and 254 in blacks. In the timeframe studied, incidence rates increased by 3 percent per year among white non-Hispanic men and 3.6 percent per year among white non-Hispanic women, increased 3.4 percent among white Hispanic women and 0.9 percent among white Hispanic men, and remained relatively stable among black men and women. However, both white Hispanics and black individuals had more advanced melanoma when they were diagnosed. Eighteen percent of white Hispanic patients and 26 percent of black patients had disease that had spread either regionally or to distant parts of their bodies, compared with 12 percent of white non-Hispanic patients. The proportion of distant-stage disease diagnosed among white Hispanic and black patients did not change significantly from 1990 to 2004, compared with a steady decrease in such advanced cases among white non-Hispanic patients. "Melanoma among darker-skinned populations has received little attention, partly reflecting their overall lower risk compared with white non-Hispanics," the authors write. "The lowest survival rates and delayed melanoma diagnosis is often seen in blacks. With the readily expanding population and increasing melanoma rate of 2.9 percent per year, melanoma among Hispanics also becomes an increasingly important public health issue."
The improvement in melanoma diagnosis among whites is encouraging, suggesting that public education and health care provider efforts can help reduce the impact of the disease. "The results of our study should motivate the expansion of melanoma awareness and screening campaigns to the minority communities, which can ultimately alleviate the disparities in melanoma outcome in these populations," the authors 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: Targeted Efforts Needed to Improve Disparities
"This study adds to a growing body of literature that identifies a pervasive and persistent disparity in the stage of melanoma diagnosis between Hispanic and black patients vs. white patients," write Claudia Hernandez, M.D., of the University of Illinois at Chicago, and Robin J. Mermelstein, Ph.D., in an accompanying editorial. "It is likely that no single risk factor will be responsible for this growing problem," they continue. "As our specialty moves forward, it is of vital importance that we not relegate our efforts exclusively to surveillance and database reviews but move quickly in an attempt to intervene. An effective education and outreach model that transcends cultural and language barriers must be formulated."
"This article offers suggestions for a number of potential points of investigation and intervention," they conclude. "It is important for physicians, researchers and the general public to realize that disparities are not inevitable. All population groups deserve equal access, equal care and an equal opportunity to enjoy good health."
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, December 21, 2009
Heart Transplant Patients Appear to Have Elevated Risk for Multiple Skin Cancers
CHICAGO—Many heart transplant patients develop multiple skin cancers, with increased risk for some skin cancers among patients with other cancers and with increasing age, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals. "Solid organ transplant recipients are at increased risk for skin cancers," the authors write as background information in the article. "Incidence, tumor burden and risk factors for skin cancer are well documented in renal transplant recipients. However, these characteristics are documented to a lesser extent in heart transplant patients, who are at least twice as likely to have skin cancer compared with renal transplant recipients." Reasons for this could include the greater use of immunosuppressive medications and an older average age at the time of transplant. Jerry D. Brewer, M.D., of Mayo Clinic, Rochester, Minn., and colleagues reviewed the records of 312 patients who had received heart transplants between 1988 and 2006. Patients had an average age of 47.4 years at the time of their transplant and information was extracted from their charts regarding overall characteristics, cancers, risk factors and death. The patients developed a total of 1,395 skin cancers; overall, 46.4 percent of the patients had developed skin cancer during the 19 years of follow-up. This included 1,236 squamous cell carcinomas and 151 basal cell carcinomas (the non-melanoma skin cancers), five malignant melanomas and three other types. When evaluating the tumor burden of the 312 patients, 76 (24.4 percent) had at least one squamous cell carcinoma, 24 (7.7 percent) had only one squamous cell carcinoma and 19 (6.1 percent) had 10 or more; in addition, 54 (17.3 percent) had at least one basal cell carcinoma, 23 (7.4 percent) had only one and two (0.6 percent) had 10 or more. Patients were more likely to develop squamous cell carcinoma if they had other types of cancer after their transplant, were older or had a known cause for their heart failure. Infection with the herpes simplex virus, being older and using a medication known as mycophenolate to suppress the immune system were associated with an increased risk of basal cell carcinoma. "Although a considerable tumor burden was found in this study, the rate of death due to skin cancer was surprisingly low. Only one patient died of skin cancer, of a melanoma," the authors write. "Health care providers and patients at our center have been educated for more than 10 years about the risk, early detection and treatment of skin cancer, which is apparent from the low mortality rate seen in the patients of this study."
"Vigilant sun protection practices, skin cancer education, regular skin examinations and daily vitamin D supplementation are appropriate interventions in these high-risk heart transplant patients," 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. 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, December 21, 2009
Aviation-Based Team Training May Influence Clinicians' Safety Behaviors
CHICAGO—Team training based on protocols originally developed for aviation crews may change safety-related behaviors and contribute to perceptions of empowerment among nurses and other surgical staff, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. Drawing on analogies between medicine and aviation, several programs have been developed to improve patient safety based on aviation crew resource management, according to background information in the article. "Developed in the late 1970s after the collision of two 747 airliners on a foggy runway in Tenerife, crew resource management focuses on both human and systems issues, improving communication, error management and work culture," the authors write. "Although aviation accidents continue to occur, the overall rate of incidents has declined and commercial aviation is now the safest form of transportation on a per-mile basis." Over the last decade, hospitals have begun to contract for crew resource management training for staff, typically in high-risk areas such as emergency, obstetrics/gynecology and surgery. To quantify the results of this training, Harry C. Sax, M.D., of Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, R.I., and colleagues studied two facilities, one 722-bed university hospital and one 247-bed affiliated community hospital. Both offered a regularly scheduled six-hour course, "Lessons from the Cockpit," to nurses, physicians and ancillary personnel in operating rooms. A perioperative checklist modeled on preflight checklists was posted in all operating rooms and use was monitored by the circulating nurse. In addition, participants completed a survey about self-empowerment before and then immediately and a minimum of two months after completing the course. A total of 509 participants underwent the training at the university hospital and 349 at the affiliated community hospital. "Not surprisingly, there was initial resistance because surgeons saw the checklists as speed bumps that hindered flow," the authors write. "The circulating nurse was then empowered to start the checklist process and the scrub nurse was instructed not to hand up the knife until the checklist was completed. Hospital administration and all clinical chiefs were broadly supportive of this process and any physician who was unwilling to participate was counseled." Consistent use of the checklist increased from 75 percent in 2002 to 100 percent in 2007. In addition, self-reporting of patient safety-related incidents increased from 709 per quarter in 2002 to 1,481 per quarter in 2008, with an increase in the willingness to report unsafe conditions or near-miss events. "Perceived self-empowerment, creating a culture of safety, rose by an average of 0.5 point in all 10 realms immediately post-training," the authors write. "This was maintained after a minimum of two months."
The results suggest that aviation-based training, when combined with other initiatives, enhances personal commitments to patient safety, the authors note. In addition, the program appears to change safety-related behaviors, particularly regarding the use of checklists and self-reporting. "Participants become aware of, and empowered, by these tools," they conclude. "Leadership of institutions must strive to foster the elusive 'culture of safety' by creating an environment that focuses on systems issues as opposed to individual blame, maintains personal accountability and encourages open communication in a supportive environment across all disciplines."
Editor's Note: Dr. Sax serves as a medical consultant to Indelta Learning Systems, LLC. Dr. Sax has received compensation for course instruction outside of University of Rochester Medical Center and Lifespan. Co-author Mr. Browne is an employee of Indelta Learning Systems, LLC. 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, December 21, 2009
Older Adults May Have a Higher Risk of Complications and Death After Abdominal Surgery
CHICAGO—The risk of complications and early death after commonly performed abdominal surgical procedures appears to be higher among older adults, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. It is estimated that one in six Americans will be age 65 or older by 2020 and that 15 percent of this population will be older than age 85, according to background information in the article. "Approximately 2 million older Americans undergo abdominal surgical operations each year," the authors note. "For clinicians, patients and families considering abdominal surgical procedures, informed decision making is challenging because of limited data regarding the risks of adverse perioperative events associated with advancing age." Nader N. Massarweh, M.D., and colleagues at University of Washington School of Medicine, Seattle, examined complication and death rates of 101,318 adults age 65 or older who underwent common abdominal procedures such as cholecystectomy (gall bladder removal), hysterectomy and colectomy from 1987 to 2004. Complications were recorded within 90 days of discharge and deaths were recorded within 90 days of hospital admission. The 90-day complication rate was 17.3 percent and the 90-day death rate was 5.4 percent. "Advancing age was associated with increasing frequency of complications (65 to 69 years, 14.6 percent; 70 to 74 years, 16.1 percent; 75 to 79 years, 18.8 percent; 80 to 84 years, 19.9 percent; 85 to 89 years, 22.6 percent; and 90 years or older, 22.7 percent) and mortality (65 to 69 years, 2.5 percent; 70 to 74 years, 3.8 percent; 75 to 79 years, 6 percent; 80 to 84 years, 8.1 percent; 85 to 89 years, 12.6 percent; and 90 years or older, 16.7 percent)," the authors note. "After adjusting for demographic, patient and surgical characteristics as well as hospital volume, the odds of early postoperative death increased considerably with each advance in age category. These associations were found among patients with both cancer and noncancer diagnoses and for both elective and nonelective admissions."
"Older adults may be less able to adapt to the stress of surgery or to the added stress of any postoperative complication, greatly increasing their risk of early mortality," the authors conclude. "These effects appear to be additive, highlighting the need for interventions to both prevent decline among older patients and avoid postsurgical complications."
Editor's Note: This research was supported by a National Institutes of Health Roadmap Multidisciplinary Clinical Research Career Development Award Grant from the National Institutes of Health and the Hartford/American Federation for Aging 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, December 21, 2009
Imaging Tests Identify Role of Allergies in Chronic Sinus Disease
CHICAGO—Exposing patients with chronic sinus disease to allergens and then obtaining repeated images by X-ray or ultrasound reveals that nasal allergies may be involved in some cases of chronic sinus disease, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Chronic disease of the maxillary sinus (the sinus cavity located in the mid-face beneath the cheeks, on either side of the nose) is common and affects a wide population of adults and children, according to background information in the article. "Although the involvement of hypersensitivity mechanisms, and especially of nasal allergy, in chronic disease of the maxillary sinuses has been recognized, the diagnostic procedures for this disorder and the relationship vary," the author writes. "There is a dearth of information regarding the direct causal involvement of hypersensitivity mechanisms of the nasal mucosa and potential consequences within the maxillary sinuses." Zdenek Pelikan, M.D., Ph.D., of Allergy Research Foundation, Breda, the Netherlands, studied 71 patients with chronic maxillary sinus disease and 16 control individuals with allergic rhinitis but no history of sinus disease. The patients with sinus disease underwent a total of 135 nasal provocation tests, in which allergens were applied to the linings of their nasal cavities, and 71 control challenges in which only phosphate-buffered saline was applied. In the control patients, 16 positive nasal provocation tests were repeated. Before and repeatedly after these tests and challenges, images were taken of the maxillary sinuses using both radiography (X-rays) and ultrasonography. Changes to the skeleton, air fluid level, thickening of the mucus membrane in the sinus and other parameters were noted. Of the 71 patients with sinusitis, 67 developed 104 positive nasal responses to the provocation tests. Of these, 89 were accompanied by significant changes to the maxillary sinus on radiographs and 83 were also associated with significant changes on ultrasonograms. No significant changes on radiographs or ultrasonograms were noted during the 71 saline control tests on patients with sinus disease, or during the 16 nasal provocation tests conducted on control patients without sinus disease. "The possible involvement of allergy, and especially of nasal allergy, in some forms of sinus disease has already been reported in the literature," the author writes. "There are a number of anatomic and physiologic similarities between the nasal mucosa and mucosa of the maxillary sinuses." The maxillary sinuses open into the nasal canal through a valve known as the ostium. If mucus membranes in the nasal cavity are swollen, the ostium can become blocked, trapping fluids in the sinus.
"In conclusion, nasal allergy may be involved in chronic disease of the maxillary sinuses in some patients," the author concludes. "Nasal challenge with allergen combined with ultrasonography and, if necessary, also with one of the radiographic imaging methods may be a useful supplement for the diagnosis of this disorder in the clinical practice, especially in children. The confirmation of involvement of nasal allergy in patients with chronic disease of the maxillary sinuses would indicate an additional treatment of the nasal allergy."
Editor's Note: Please see the article for additional information, including 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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