CT Screening For Lung Cancer Can Be Cost-Effective If Right Patients Offered Screening

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756MedicalResearch.com Interview with:
William C. Black, MD

Professor of Radiology
Department of Radiology
Dartmouth-Hitchcock Medical Center
Lebanon, NH 03756

Medical Research: What is the background for this study? What are the main findings?

Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014.

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Patients With Severe Mental Illness Find Supportive Community On YouTube

MedicalResearch.com Interview with:

John A. Naslund, MPH – PhD Student at The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH

Stuart W. Grande, PhD, MPA – Post–doctoral fellow at The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH

Medical Research: What are the main findings of the study?

Naslund: In this study we explored whether people with severe mental illness such as schizophrenia, schizoaffective disorder, or bipolar disorder, use a popular social media website like YouTube to naturally provide and receive peer support. We found that people with severe mental illness use YouTube to feel less alone and to find hope, to support and to defend each other, and to share personal stories and strategies for coping with day-to-day challenges.  

Dr. Grande: They also sought to learn from the experiences of others about using medications and seeking mental health care.  YouTube appears to serve as a platform that helps these individuals to overcome fears associated with living with mental illness, and it also creates a sense of community among them.
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Melanoma Cells Alter Their Environment To Promote Progession

Dr. Constance Brinckerhoff Professor of Medicine Professor of Biochemistry Geisel School of Medicine at DartmouthMedicalResearch.com Interview with:
Dr. Constance Brinckerhoff
Professor of Medicine
Professor of Biochemistry
Geisel School of Medicine at Dartmouth


Medical Research: What are the main findings of the study?

Dr. Brinckerhoff: The genetic mutation BRAFV600E , frequently found in metastatic melanoma, not only secretes a protein that promotes the growth of melanoma tumor cells, but can also modify the network of normal cells around the tumor to support the disease’s progression. Targeting this mutation with Vemurafenib reduces this interaction, and suggests possible new treatment options for melanoma therapy.
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Team Approach Improved Patient Safety From Cath Lab Procedures

MedicalResearch.com Interview with: Jeremiah R. Brown, PhD MS Assistant Professor of Health Policy and Clinical Practic The Dartmouth Institute Lebanon, NHMedicalResearch.com Interview with:
Jeremiah R. Brown, PhD MS
Assistant Professor of Health Policy and Clinical Practic
The Dartmouth Institute
Lebanon, NH

 

Medical Research: What are the main findings of the study?

Dr. Brown: Using simple team-based quality improvement methods we prevented kidney injury in 20% of patients having a procedure in the cardiac catheterization lab.  Among patients with pre-existing kidney disease, we prevent kidney injury in 30% of patients.

We believed that using a team-based approach and having teams at different medical centers in northern New England learn from one-another to provide the best care possible for their patients.  Some of the most innovative ideas came from these teams and identified simple solutions to protect patients from kidney injury from the contrast dye exposure; these included:

  • Getting patients to self-hydrate with water before the procedure (8 glasses of water before and after the procedure),
  • Allow patient to drink fluids up to 2-hours before the procedure (whereas before they were “NPO” for up to 12 hours and came in dehydrated),
  • Training the doctors to use less contrast in the procedure (which is good for the patient and saves the hospital money),
  • and creating stops in the system to delay a procedure if that patient had not received enough oral or IV fluids before the case (rather, they would delay the case until the patient received adequate fluids).Our success was really about hospital teams talking and innovating with one another instead of competing in the health care market, which resulted in simple, homegrown, easy to do solutions that improved patient safety.

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Epilepsy: Readmissions Increased By Refractory Seizures and Psychiatric Comorbidities

MedicalResearch.com Interview with:
Tracie A. Caller, MD , MPH
Neurophysiology Fellow
Dartmouth-Hitchcock Medical Center
1 Medical Center Dr., Lebanon NH 03756, USA

MedicalResearch: What are the main findings of the study?

Dr. Caller: We identified factors that appeared to increase the risk for a 30 day readmissions in the epilepsy population, which included refractory seizures but also coexistence of nonepileptic seizures and psychiatric comorbidities.
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Contraception Decision-Making: What Are Women’s Priorities?

Rachel Thompson PhD Postdoctoral Research Fellow The Dartmouth Center for Health Care Delivery Science Dartmouth CollegeMedicalResearch.com: Interview with
Rachel Thompson PhD
Postdoctoral Research Fellow
The Dartmouth Center for Health Care Delivery Science
Dartmouth College


MedicalResearch: What are the main findings of the study?

Dr. Thompson: This study, which surveyed 417 women aged 15-45 years and 188 contraceptive care providers in 2013, found important differences in what matters most to these two groups when it comes to discussing and deciding on a contraceptive method. Women’s most important question when choosing a contraceptive was “Is it safe?” – this was in the top three questions for 42% of women but only 21% of providers. Alternatively, providers’ most important question was “How is it used?”. Information on side effects and how a method actually works to prevent pregnancy was also a higher priority for women than for providers.
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Appendix Tumors Demonstrate All Cancers Are Not the Same

Gregory J. Tsongalis, PhD, HCLD, CC, FNACB Professor of Pathology Director, Molecular Pathology Co-Director, Translational Research Program Department of Pathology Dartmouth Hitchcock Medical Center and The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756MedicalResearch.com Interview with:
Gregory J. Tsongalis, PhD, HCLD, CC, FNACB
Professor of Pathology
Director, Molecular Pathology
Co-Director, Translational Research Program
Department of Pathology
Dartmouth Hitchcock Medical Center and
The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756

MedicalResearch: What are the main findings of the study?

Dr. Tsongalis: This was the first study of its kind looking at multiple genes and multiple mutations in tumors of the appendix. Many of the identified mutations may be clinically actionable with respect to response to therapy or selection of therapy.

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Stroke: Fragmentation of Care Leads To More CT Scans, Higher Costs

Kimon Bekelis, MD Department of Neurosurgery Dartmouth-Hitchcock Medical CenterDr. BekelisMedicalResearch.com Interview with:
Kimon Bekelis, MD
Department of Neurosurgery
Dartmouth-Hitchcock Medical CenterDr. Bekelis

 

MedicalResearch.com: What are the main findings of the study?

Dr. Bekelis: We demonstrated  extensive regional and racial variation in the utilization of head CT scans in the first year after ischemic stroke. Increased use paralleled spending in corresponding Hospital Referral Regions. Greater fragmentation of care was associated with high intensity head CT utilization. African-Americans were associated with increased fragmentation of care and utilization of head CT.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Bekelis:  The extensive regional variation in the use of head CT for ischemic stroke has not been demonstrated before. In addition, the racial disparities in these practices are striking and are also reported for the first time. We identified that a major component of these utilization patterns is fragmentation of care, an issue not addressed previously through health care reforms. Hopefully the implementation of Accountable Care Organizations will minimize disparities and maximize continuity of care, with potential impacts in cost and overultilization.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Bekelis:  We demonstrated that fragmentation of care is associated with overutilization of costly and potentially hazardous imaging modalities. From a physician’s perspective, every effort should be made to maintain continuity of care and enhance communication between providers in order to minimize this dangerous practice. Patients should avoid seeing multiple providers and be critical of unnecessary use of CT scans. Initiatives such as the “Choosing Wisely Campaign” can assist patients with decision-making.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Bekelis:  The best performing Hospital Referral Regions in terms of utilization and cost should be studied further. The particular practice patterns in these areas, and their methods of ensuring continuity of care should be identified. They can be used as examples that can be mirrored in order to maximize efficiency and minimize cost in the constantly changing health care landscape.

Citation:

Fragmentation of Care and the Use of Head Computed Tomography in Patients With Ischemic Stroke.

Bekelis K1, Roberts DW, Zhou W, Skinner JS.
Circ Cardiovasc Qual Outcomes. 2014 Apr 8. [Epub ahead of print]

Young Children Misidentify Foods in Fast Food Ads Aimed At Kids

dr_james_d_sargentMedicalResearch.com Interview with
James D. Sargent, MD, Professor of Pediatrics
Professor of Community and Family Medicine
Professor of The Dartmouth Institute
Co-Director, Cancer Control Research Program
Norris Cotton Cancer Center Norris Cotton Cancer Center,
Department of Pediatrics
Geisel School of Medicine at Dartmouth
Lebanon, New Hampshire


MedicalResearch.com: What are the main findings of the study?

Dr. Sargent: We showed children aged 3-7 years depictions of healthy foods in McDonald’s and Burger King television advertisements that aired in 2010-11.  Children were asked what they saw in the images and not prompted to respond specifically to any aspect of the images.  All images contained the two healthy foods—apples and milk—the companies purported to be advertising through the Children’s Food and Beverage Advertising Initiative.  Only 52% and 70% of children correctly identified McDonald’s and Burger King images of milk.  Whereas 80% correctly identified McDonald’s image of apples, only 10% identified the Burger King apples as apples.  Instead, 81% mistook them as french fries.

Please see the video of children responding to the BK apples depiction at

http://cancer.dartmouth.edu/about_us/newsdetail/66129/

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Expanded Health Insurance: Hospital Services Use by Young Adults with Behavioral Diagnoses

MedicalResearch.com Interview with:
Ellen R. Meara Associate Professor of The Dartmouth Institute Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College Ellen R. Meara
Associate Professor of The Dartmouth Institute
Adjunct Associate Professor in Economics & Nelson A. Rockefeller Center for Public Policy, Dartmouth College


MedicalResearch.com: What are the main findings of this study?

Answer: When insurance coverage for young adults rose by over 15 percentage points following Massachusetts’ 2006 health reform, use of inpatient care for mental illness and substance use disorders fell and emergency department visits for these conditions grew more slowly for 19 to 25 year olds in Massachusetts relative to other states. Also, their care was much more likely to be paid for by private or public insurance insurers.

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Breast Imaging with Combined MRI and Near Infrared Spectroscopy

Michael Mastanduno Thayer School of Engineering, Dartmouth College 14 Engineering Dr. Hanover, NH 03755MedicalResearch.com Interview with:
Michael Mastanduno
Thayer School of Engineering, Dartmouth College
14 Engineering Dr.
Hanover, NH 03755


MedicalResearch.com: What are the main findings of the study?

Answer: The study was able to illustrate the design and clinical testing of an MRI breast coil for combined MRI and Near Infrared Spectroscopy. The coil was tested on 8 healthy volunteers spanning all bra cup sizes and mammographic density categories. In the past, MRI/NIRS imaging was only possible in C and D cup sized breasts. The system also will give researchers the ability to target lesions in hard-to-reach areas close to the chest wall. With the successful completion of this study, simultaneous MRI/NIRS is possible in all breast sizes, tissue compositions, and lesion locations.
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Women exposed to diethylstilbestrol in the womb face increased cancer risk

A large study of the daughters of women who had been given DES, the first synthetic form of estrogen, during pregnancy has found that exposure to the drug while in the womb (in utero) is associated with many reproductive problems and an increased risk of certain cancers and pre-cancerous conditions. The results of this analysis, conducted by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and collaborators across the country, were published Oct. 6, 2011, in the New England Journal of Medicine.

Beginning in 1940, diethylstilbestrol, known as DES, was used clinically to prevent certain complications of pregnancy. In the 1950s, clinical studies showed DES was ineffective for this purpose. In the late 1960s, an unusual occurrence of a rare cancer of the vagina among young women, called clear cell adenocarcinoma (CCA), was observed and subsequently linked to their exposure to DES while in the womb.

In 1971, the U.S. Food and Drug Administration notified physicians that DES should not be prescribed to pregnant women. However, between 5 million and 10 million pregnant women and babies had been exposed to the drug. It was manufactured under many different product names, and came in various forms, including pills, creams and vaginal suppositories.

“Our study carefully documents elevated risk for DES-exposed daughters for a host of medical problems — many of them also quite common in the general population,” said study author Robert N. Hoover, M.D., director of the Epidemiology and Biostatistics Program in NCI’s Division of Cancer Epidemiology and Genetics. “Without the sentinel finding of a very rare cancer in young women, and without the sustained follow-up of those who were exposed, we would not know the full extent of harm caused by DES exposure in the womb.”

In this study, which included over 6,500 women (4,600 exposed and 1,900 unexposed), the researchers found that the daughters with exposure to DES while in the womb had an increased risk of 12 medical conditions, including a twofold higher risk of infertility and a fivefold increased risk of having a preterm delivery. (See table below for complete list of increased risks.)

This study is also the first to estimate the cumulative proportion of all DES-exposed women who developed these conditions because of their exposure. Of all DES-exposed women, 1 in 5 will experience some level of infertility because of their exposure. And of all those exposed women who are successful in having at least one birth, 1 in 3 will have a preterm delivery due to DES.

Although DES-exposed daughters have about 40 times the risk of developing CCA than unexposed women, CCA is still a rare disease, occurring in 1 in 1,000 DES-exposed daughters. While the first women diagnosed with this condition in the late 1960s were adolescents and young adults at the time of their diagnosis, the research now shows that the risk for DES-exposed daughters continues through at least age 40. In addition, these women are more than twice as likely to develop pre-cancerous cells in the cervix or vagina (called cervical intraepithelial neoplasia) and have an 80 percent higher chance of developing breast cancer after age 40. According to the results of this study, by age 55, 1 in 25 DES-exposed daughters will develop abnormal cellular changes in the cervix or vagina, and 1 in 50 will develop breast cancer due to their DES exposure.

This study was the first to assess risk based on the presence of vaginal epithelial changes as a biomarker of timing and dose of DES exposure. Exposed daughters with higher total dose of DES and younger age of the embryo at first exposure had evidence of these changes in the lining of the vagina. Women with these changes were at even greater risk for 9 of the 12 conditions compared to exposed women who did not have the biomarker.

This study did not evaluate sons with DES exposure in the womb, but previous reports have indicated an increased risk for certain testicular abnormalities, including undescended testicles or the development of cysts in the epididymis, tightly coiled tubes connected to the testicles. As DES-exposed sons grow older, more data will be available to assess their cancer risk. So far, research has shown no decreased fertility for these men, even with testicular abnormalities.

The women in this study were followed as part of the NCI’s DES Follow-up Study, which began in 1992. NCI researchers will continue to study DES-exposed daughters as they move into menopausal years. The cancer risks for exposed daughters, as well as sons, are continually being studied to determine if they differ from an unexposed population. In addition, researchers are studying possible health effects on the grandchildren of mothers who took DES during pregnancy, because some of the genetic changes caused by DES exposure in the womb may be inherited.

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The other research centers involved in this work are Boston University Slone Epidemiology Center, Boston; Cedars-Sinai Medical Center DES Project, Los Angeles; University of Chicago Department of Obstetrics and Gynecology; Dartmouth-Hitchcock Medical Center, Lebanon, N.H.; The Mayo Clinic DES Project, Rochester, Minn.; The Methodist Hospital-Research Institute Department of Obstetrics and Gynecology, Houston; and Tufts Medical Center, Boston.

For more information about DES exposure and cancer risk, please go to http://www.cancer.gov/cancertopics/factsheet/Risk/DES.