(Press-News.org) 1. Breast density notification laws substantially increase costs yet save few lives
Laws requiring women to be notified of their breast density so that they may discuss supplemental screening options, including ultrasound, with their health care providers would substantially increase costs and save relatively few lives, according to an article published in Annals of Internal Medicine. More than 40 percent of women between the ages of 40 and 74 have dense breast tissue, which puts them at increased risk for breast cancer and affects how well a mammogram can detect abnormalities. As such, at least 19 states have enacted breast density notification laws so that women can make informed decisions about supplemental screening. With similar legislation being considered at a national level, researchers sought to determine the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Three validated simulation models predicted that supplemental ultrasound screening after a negative mammogram for women with dense breasts would result in limited health gains and substantially increased expenses. According to model estimates, supplemental screening for women with dense breasts and a negative mammogram would save 0.36 additional breast cancer deaths, gain 1.7 quality adjusted life years (QALYs), and result in 354 false-positive ultrasound biopsy recommendations per 1,000 women with dense breasts compared to biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained, but costs could be improved by restricting supplemental ultrasound screening to women with extremely dense breasts.
Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Sarah Keblin at sarah.keblin@med.uvm.edu or 802-656-3099.
2. Institute of Medicine 'Dying in America' report sparks discussion and debate
Four commentaries published in Annals of Internal Medicine discuss the recent report from the Institute of Medicine (IOM) titled "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life." Each commentary offers a different perspective on the topic of end-of-life care.
IOM Committee on Approaching Death co-chair, Philip A Pizzo, MD, discusses the importance of compassionate care that is respectful of patients' end-of-life preferences. He suggests that physicians, such as oncologists who care for seriously ill patients, should be open and honest with patients when discussing their treatment options and should remain fully present after palliative or hospice care has begun. Note: To interview Dr. Pizzo, please contact Ruthann Richter at richter1@stanford.edu or 650-725-8047.
Drs. Scott Halpern and Ezekiel Emanuel from the Department of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania recognize that sweeping overhauls in the delivery of end-of-life care are greatly needed. However, reimbursing physicians for engaging patients in advance care planning may not be the best approach. They explain some of the opportunities outside of physician incentives to improve the quality of end-of-life care. Note: To interview Dr. Halpern, please contact Emily Kane at emkane@exchange.upenn.edu or 215-898-0861. To interview Dr. Emanuel, please contact Beth Dunn at bethwalk@upenn.edu or 215-573-9384.
Debra L Ness, MS, from the National Partnership for Women and Families and Beverley H. Johnson, BSN, from the Institute for Patient- and Family-Centered Care, applaud the IOM for initiating a national conversation about end-of-life care. However, they argue that the report needs an authentic patient-and family-centered approach that focuses on working with rather than for patients and families. Note: To reach Debra Ness, please contact Cindy Romero at cromero@nationalpartnership.org or 202-986-2600.
Annals of Internal Medicine Deputy Editor, Jaya K. Rao, MD, MHS, praises the IOM report for suggesting that end-of-life care is a public health issue, a concept she championed while working for the Centers for Disease Control and Prevention (CDC) from 2000 to 2008. According to Dr. Rao, end-of-life care meets the criteria to be a public health priority. She hopes that members of the IOM Committee and health professionals will build on the report recommendations to educate and engage the public about this serious issue. Note: To interview Dr. Rao, please contact Angela Collom at acollom@acponline.org or 215-351-2653.
News from Annals of Internal Medicine Dec. 8, 2014
2014-12-09
ELSE PRESS RELEASES FROM THIS DATE:
Major complications after abortion are extremely rare, study shows
2014-12-09
In the most comprehensive look yet at the safety of abortion, researchers at UC San Francisco have concluded that major complications are rare, occurring less than a quarter of a percent of the time, about the same frequency as colonoscopies.
The study, published online on Monday, Dec. 8, 2014, in Obstetrics & Gynecology, analyzed data from more than 50,000 women enrolled in the Medi-Cal fee-for-service program who obtained abortions from 2009 to 2010, and looked for complications that occurred within six weeks of the procedure.
The rate is similar to what has been ...
Scientists discover brain mechanism that drives us to eat glucose
2014-12-09
Glucose is a component of carbohydrates, and the main energy source used by brain cells.
By studying rats, a team at Imperial College London identified a mechanism that appears to sense how much glucose is reaching the brain, and prompts animals to seek more if it detects a shortfall.
The researchers believe it may play a role in driving our preference for sweet and starchy foods.
The study, funded by the Biotechnology and Biological Sciences Research Council, is published in the Journal of Clinical Investigation.
Dr James Gardiner, from the Department of Medicine, ...
Modified heat shock protein identified as plasma cell dyscrasis risk factor
2014-12-09
Patients with plasma cell dyscrasis have high amounts of an abnormal immunoglobulin, called a paraprotein, in their blood. While many patients have no outward symptoms, paraproteins can impair immune function, thicken blood, and damage organs. Plasma cell dyscrasis may be inherited, but risk factors for this disease are poorly understood. A new study in the Journal of Clinical Investigation suggests that the presence of a modified host protein is associated with plasma cell dyscrasis risk. Michael Pfreundschuh and colleagues evaluated paraproteins in blood from patients ...
Glucokinase activation enhances sugar craving in rodents
2014-12-09
Glucose is the primary fuel for the brain. Therefore, it has been proposed that the brain must sense glucose and promote eating behaviors when levels are low. A new study in the Journal of Clinical Investigation reveals that activation of an enzyme, glucokinase, in a region of the hypothalamus called the arcuate nucleus specifically increases glucose uptake. Steve Bloom and colleagues at Imperial College London determined that glucokinase levels in the arcuate nucleus are dramatically increased in fasted rats. In their rodent models, activation of glucokinase in the acruate ...
Dunes on Titan need firm winds to move, experiments at ASU show
2014-12-09
Saturn's largest moon, Titan, is one of the few solar system bodies - and the only planetary moon - known to have fields of wind-blown dunes on its surface. (The others are Venus, Earth and Mars.)
New research, using experimental results from the high-pressure wind tunnel at Arizona State University's Planetary Aeolian Laboratory, has found that previous estimates of how fast winds need to blow to move sand-size particles around on Titan are about 40 percent too low.
A team of scientists led by Devon Burr of the University of Tennessee, Knoxville reported the findings ...
NASA-funded FOXSI to observe X-rays from Sun
2014-12-09
An enormous spectrum of light streams from the sun. We're most familiar with the conventional visible white light we see with our eyes from Earth, but that's just a fraction of what our closest star emits. NASA regularly watches the sun in numerous wavelengths because different wavelengths provide information about different temperatures and processes in space. Looking at all the wavelengths together helps to provide a complete picture of what's occurring on the sun over 92 million miles away - but no one has been able to focus on high energy X-rays from the sun until recently.
In ...
Experience counts with radiation therapy for head and neck cancer, study shows
2014-12-09
COLUMBUS, Ohio - When it comes to specialized cancer surgery, it's generally true that the more experienced the surgeon, the better the outcome. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study led by researchers Evan Wuthrick, MD, assistant professor of radiation oncology at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), and Maura Gillison, MD, PhD, professor of internal medicine and epidemiology at the OSUCCC - ...
Hookah smoking increases risk of subsequent cigarette smoking among adolescents
2014-12-09
A team of researchers at Dartmouth College and University of Pittsburgh found respondents who had smoked water pipe tobacco but not smoked cigarettes were at increased risk of cigarette smoking two years later as recently published online in JAMA Pediatrics. The study followed 2,541 adolescents and young adults for two years.
Samir Soneji, PhD, a tobacco regulatory control researcher at Dartmouth and lead author on the study said, "We found hookah smoking increased the probability of trying cigarette smoking over the next two years by 19%."
This longitudinal study ...
Cans lined with Bisphenol A may increase blood pressure
2014-12-08
Drinking or eating from cans or bottles lined with Bisphenol A (BPA) could raise your blood pressure, according to new research reported in the American Heart Association's journal Hypertension.
BPA, a chemical used as an epoxy lining for cans and plastic bottles, is everywhere, and its consumption has been associated with high blood pressure and heart rate variability. Previous studies have shown that BPA can leach into foods and drinks.
"A 5 mm Hg increase in systolic blood pressure by drinking two canned beverages may cause clinically significant problems, particularly ...
Primary care doctors report prescribing fewer opioids for pain
2014-12-08
Nine in 10 primary care physicians say that prescription drug abuse is a moderate or big problem in their communities and nearly half say they are less likely to prescribe opioids to treat pain compared to a year ago, new Johns Hopkins Bloomberg School of Public Health research suggests.
Primary care doctors also appear to recognize many risks of prescription opioid use, including addiction and death by overdose, according to the findings reported in the Dec. 8 issue of JAMA Internal Medicine.
"Our findings suggest that primary care providers have become aware of the ...