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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