(Press-News.org) 1. Placebo delivery method affects patient response to "therapy"
Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-0623
URLs go live when embargo lifts
A systematic evidence review published in Annals of Internal Medicine finds that the way in which a placebo is delivered makes a difference in how patients respond to "therapy." Having a clinically significant response to the sham treatment could substantially affect outcomes in placebo-controlled trials. The data suggests that some placebos have a stronger effect than others.
Placebo controls, or supposedly ineffectual treatments, help to maintain blinding in evaluations of the effectiveness of medical treatments in clinical trials. It is unclear whether different placebo delivery methods yield different effects. Using knee osteoarthritis as an example, researchers reviewed 149 randomized trials comparing widely used pharmaceuticals against the following four placebos: oral, intra-articular, topical, and oral plus topical to quantify the effect of differential placebo effects on active-treatment effect estimates. The researchers concluded intra-articular and topical placebo interventions were associated with greater responses than oral placebo. This finding supports the notion that placebo treatments can exert clinically relevant effects and that the possibility of differential placebo effects need to be considered in assessment of the relative efficacies and rankings of active treatments versus different placebos.
Notes: For an embargoed PDF, please contact Cara Graeff or Steve Majewski. To speak with the lead author, Dr. Raveendhara Bannuru, please contact Jeremy Lechan at JLechan@tuftsmedicalcenter.org or 617-636-0104.
2. Wide variations in blood pressure linked to heart disease and death
Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M14-2803
URLs go live when the embargo lifts
Higher variability of blood pressure readings between outpatient visits is associated with an increased risk for heart disease and death, according to a study published in Annals of Internal Medicine.
Previously, variations in blood pressure readings across outpatient visits were dismissed as a random fluctuation around a patient's true underlying blood pressure. Recent research has found an association between blood pressure variances and increased risk for stroke and heart disease, but other studies failed to reach the same conclusion.
Researchers studied data for 25,814 patients participating in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to examine the association of visit-to-visit variability of systolic blood pressure and diastolic blood pressure with cardiovascular disease and mortality outcomes. The data showed a strong association between wide fluctuations in systolic blood pressure and fatal coronary heart disease or nonfatal myocardial infarction, all-cause mortality, stroke, and heart failure. Variations in diastolic blood pressure was also associated with these outcomes. The authors stress that their secondary analysis of ALLHAT data is presented using an observational study design and, therefore, causality cannot be determined.
Notes: For an embargoed PDF, please contact Cara Graeff or Steve Majewski. To reach the lead author, Dr. Paul Muntner, please contact Nicole Wyatt, 205-934-8938, nwyatt@uab.edu.
3. Study quantifies the cost of top medical board's physician certification program
Free abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1011
URLs go live when the embargo lifts
The American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) MOC requirements will cost internal medicine physicians an average of $23,607 over 10 years, ranging from $16,725 for general internists to $40,495 for hematologists-oncologists, according to a cost analysis published in Annals of Internal Medicine. The expenses include $2,349 in fees to ABIM and $21,259 in time costs. Cumulatively, the 10-year MOC cycle will cost $5.7 billion between 2015 and 2024, $1.2 billion more than the previous ABIM recertification process.
Testing costs include annual fees paid to ABIM to access online modules and retesting fees for physicians who failed their first recertification examination. Time costs capture the market value of the time physicians spend completing MOC and related documentation. Time accounts for $9 of every $10 spent on MOC.
The authors conclude that MOC reform should focus on decreasing the time required to fulfill MOC requirements and increasing integration with existing CME activities. A rigorous evaluation of MOC's effect on clinical and economic outcomes is warranted to better balance potential gains in the quality and efficiency of clinical care against the costs.
Notes: For an embargoed PDF, please contact Cara Graeff or Steve Majewski. To reach the lead author, Dr. Dhruv S. Kazi, please contact Scott Maier at Scott.Maier@ucsf.edu or 415-476-3595.
INFORMATION:
Also in this issue:
Using Agent-Based Models to Address "Wicked Problems" Like Tobacco Use: A Report from the Institute of Medicine
Nancy A. Rigotti, MD, and Robert B. Wallace, MD, MSc
Ideas and Opinions
M15-1567
http://www.annals.org/article.aspx?doi=10.7326/M15-1567
Pragmatic Randomized Trials Without Standard Informed Consent? A National Survey
Rahul K. Nayak, BSE; David Wendler, PhD; Franklin G. Miller, PhD; and Scott Y.H. Kim, MD, PhD
Original Research
M15-0817
http://www.annals.org/article.aspx?doi=10.7326/M15-0817
The University of Colorado Cancer Center and Loxo Oncology, Inc. (Nasdaq:LOXO), a biopharmaceutical company focused on the discovery, development and commercialization of targeted cancer therapies, today announced the publication of a research brief in the online edition of the journal Cancer Discovery, describing the first patient with a tropomyosin receptor kinase (TRK) fusion cancer enrolled in the Phase 1 dose escalation trial of LOXO-101, the only selective TRK inhibitor in clinical development. Additional contributors to the paper include the Knight Cancer Institute ...
RIVERSIDE, Calif. -- When it comes to installing solar cells, labor cost and the cost of the land to house them constitute the bulk of the expense. The solar cells -- made often of silicon or cadmium telluride -- rarely cost more than 20 percent of the total cost. Solar energy could be made cheaper if less land had to be purchased to accommodate solar panels, best achieved if each solar cell could be coaxed to generate more power.
A huge gain in this direction has now been made by a team of chemists at the University of California, Riverside that has found an ingenious ...
A Johns Hopkins-led study of outcomes among 1,200 people with implanted defibrillators -- devices intended to prevent sudden cardiac death from abnormal heart rhythms -- shows that within a few years of implantation, one in four experienced improvements in heart function substantial enough to put them over the clinical threshold that qualified them to get a defibrillator in the first place.
A report on the study, published in the Aug. 4 issue of the Journal of the American College of Cardiology, reveals these patients had markedly lower risk of dying and were far less ...
In a project spearheaded by investigators at UC San Francisco, scientists have devised a new strategy to precisely modify human T cells using the genome-editing system known as CRISPR/Cas9. Because these immune-system cells play important roles in a wide range of diseases, from diabetes to AIDS to cancer, the achievement provides a versatile new tool for research on T cell function, as well as a path toward CRISPR/Cas9-based therapies for many serious health problems.
Using their novel approach, the scientists were able to disable a protein on the T-cell surface called ...
Use of gene therapy to deliver a protein that suppresses the development of female reproductive organs may improve the survival of patients with ovarian cancer that has recurred after chemotherapy, which happens 70 percent of the time and is invariably fatal. In their report receiving online publication in PNAS Early Edition, a Massachusetts General Hospital (MGH) research team describes how a single injection of a modified version of Mullerian Inhibiting Substance, a protein critical to sexual development, carried on a commonly used viral vector suppressed the growth ...
As many as 20 percent of people may have a benign cyst or tumor in their pituitary gland. The vast majority of pituitary tumors are noncancerous, but can cause headaches and profound fatigue, and can also disrupt hormone function. Currently, surgeons rely on radiologic images and MRIs to gather information about the size and shape of the tumor, but the resolution of such imaging technologies is limited, and additional surgeries to remove more of the tumor may be needed if a patient's symptoms persist. In a new study published in the Proceedings of the National Academy ...
Estimates of how much nitrous oxide, a significant greenhouse gas and stratospheric ozone-depleting substance, is being emitted in the central United States have been too low by as much as 40 percent, a new study led by University of Minnesota scientists shows.
The study, published today in the journal Proceedings of the National Academy of Sciences, measured how much nitrous oxide is emitted from streams in an agriculturally dense area in southern Minnesota. Agriculture, and specifically nitrogen fertilizers used in row-crop farming, is a major contributor to nitrous ...
SAN FRANCISCO, CALIF. - July 27, 2015 - Two new studies presented today at the Society of NeuroInterventional Surgery 12th Annual Meeting in San Francisco, report that Mobile Stroke Treatment Units (MSTUs) can significantly reduce the time it takes to diagnose and treat patients for stroke, greatly improving survival rates and enhancing a patient's chance of recovery.
There are currently four MSTUs in use worldwide. Two are in Germany and two are in the United States (U.S.) - one in Cleveland and one in Houston. MSTUs resemble ambulances on the outside, but contain ...
LAWRENCE -- Providing two years of free community college to qualifying students is expected to be a hot topic during the 2016 presidential campaign.
President Barack Obama introduced the plan earlier this year, aimed at boosting educational attainment and workforce opportunities of thousands of students -- especially those from low-income families. Support for expanded education is not the purview of one party, however; President George W. Bush also frequently referenced the significance of two-year colleges. Tennessee and Oregon are offering free community college to ...
MADISON, Wis. - Ten thousand years ago, a golden grain got naked, brought people together and grew to become one of the top agricultural commodities on the planet.
Now, University of Wisconsin-Madison researchers have found that just a single letter change in the genetic script of corn's ancestor, teosinte, helped make it all possible.
Publishing in the journal Genetics this month, UW-Madison professor John Doebley and a team of researchers describe how, during the domestication of corn, a single nucleotide change in the teosinte glume architectural gene (tga1) stripped ...
