By jeremyc | December 4, 2013
The American Joint Committee on Cancer (AJCC) stage and Tumor grade are the most important mortality predictors in risk analysis of renal cell carcinoma (RCC) patients undergoing nephrectomy. This was reported by a recent study done by Maxine Sun and colleagues from the University of Montreal Health Center in Quebec, Canada.
According to the researchers, however, noncancerous causes of death also had a large impact on patients of or over 70 years of age, regardless of the grade and stage of the tumor. Data on 42,090 RCC patients in the Surveillance, Epidemiology, and End Results database was analyzed for this study.
“In consequence, further work is needed regarding the management of elderly patients diagnosed with organ-confined RCC, such as a more comprehensive assessment of the risks and benefits of surgical intervention and better attempts at preventing as well as decreasing postoperative morbidities from treatment,” said the researchers.
During the five-year follow-up, researchers found that cancer-specific mortality rates increased significantly with the stage of cancer, even as the tumor grade and patient age increased. The mortality rate was 2-9 percent for patients with stage 1 cancer, and 54-79 percent for those in stage 4. It was 2-64 percent for patients with low-grade tumors and 6-79 percent for high-grade tumor patients.
The team said about these results, “his underlines the need of an accurate patient selection even in this group of patients, especially when planning aggressive surgery, or a potentially harmful chemotherapy.”
By jeremyc | December 3, 2013
A recently-published randomized trial study showed that community pharmacist-based intervention helped chronic obstructive pulmonary disease (COPD) patients improve their treatment adherence. More specifically, it helped improve their medication adherence and inhalation technique.
The study was led by Eline Tommelein from the Ghent University, Belgium, and colleagues. The Pharmaceutical Care for COPD (PHARMACOP) study also suggested that this community pharmacist-led approach to COPD treatment can reduce the rate of severe exacerbations in patients. The single-blind trial involved 734 patients and 170 community pharmacies. The COPD patients were aged 50 years and above and smoked for at least 10 pack years.
A total of 371 patients were assigned protocol-defined pharmacist care and the remaining 363 were assigned usual pharmacist care. The first group received two personal counseling sessions on COPD and medications, along with a discussion on using their inhalers, self-management, medication adherence, and smoking cessation.
At baseline, around 15.6 percent of the first intervention group and 11.6 percent of the control group made major errors in using their medication and inhalation device. After a month, only 1.2 percent of the intervention group made errors, while the percentage in the control group was 4.6 percent.
Moreover, the number of patients who scored 100 percent in their inhalation technique increased significantly in the intervention group. It rose from 22.4 percent to 68.5 percent in one month, as compared to the rise from 16.5 percent to 32.9 percent in the control group.
By jeremyc | December 2, 2013
A recent study showed that there was no significant difference in rates of neurocognitive impairments in males and females in early psychosis. The study was led by Rosa Ayesa-Arriola and colleagues from the University of Cantabria in Santader, Spain.
Despite the lack of significant gender differences, the researchers did find a subgroup of female psychosis patients who had significant differences in the pattern and degree of cognitive impairment with respect to male patients.
According to the researchers, this is one of the largest studies to explore differences in neuro-cognition in male and female first-episode psychosis patients. A total of 74 women and 86 men were tested within the sixth and 13th week after their first psychotic episode.
The test results of the male and female patients were compared, and researchers saw that there was no significant difference in the neurocognitive performance of the two groups. However, the women did score higher than men on verbal memory and men scored higher on reaction time, executive functions, and visual memory. On further analysis, it was found that women did better in terms of verbal learning and men did better in terms of visuospatial abilities and working memory.
The researcher said about these results, “These results confirm gender-related differences in certain neuropsychological domains.” They added, “We consider this to be an interesting issue to be further explored in order to elucidate whether sex specific deficits require special rehabilitation programs for patients with schizophrenia.”
By jeremyc | December 1, 2013
The findings from a recent study indicate that analyzing the first manic episode in bipolar disorder patients can predict the degree and type of future morbidity and course of the disease. The study involved analysis of clinical records and life charts from 1081 bipolar patients in Italy.
The median follow-up period for the study was 15.7 years, during which it was found that depression was seen in 58.9 percent of the patients’ first episode. Other common presentations for a first episode were mania, psychosis, anxiety, and hypomania, which were found in 58.9, 13.4, 8.0, and 7.6 percent of patients respectively.
The patients whose first episode was characterized by anxiety, depression, and/or mixed states, were later associated with suicidal thoughts/actions, depression, and antidepressant usage. The patients whose first episode was characterized by mania or psychosis later had manic episodes. Most notably, depressive first episodes were more common among bipolar disorder II patients than bipolar disorder I patients.
The researchers commented on these results, “Such associations should contribute to formulating earlier and more reliable prognosis in patients with [bipolar disorder], predicting treatment responses, [and] long-range planning for their clinical care.”
The study also showed that antidepressants were used by 65.4 percent of patients and strongly associated with anxiety and depression in the first episode.
By jeremyc | November 30, 2013
Insomnia and its effect on health is a major concern for patients being treated for heart failure, according to a recent study. The research team associated with this study was led by Laura Kierol Andrews from the Yale University School of Nursing, New Haven, Connecticut.
Discussing their results, the researchers said, “Our findings underscore the critical importance of evaluating sleep, including insomnia.” They found that 11 heart failure patients participating in the study rarely if ever discussed sleep concerns with their doctors. This was despite the patients stating that they wanted relief from the problem. Moreover, they wanted the doctor to personally ask them how well they were sleeping.
The patients were found to have poor sleep quality according to the Pittsburgh Sleep Quality Index, and moderate insomnia according to the Insomnia Severity Index. Patients slept for an average of 5.18 hours per night and found it hard to fall asleep. They also reported waking up after sleep onset, waking up too early, and insufficient sleep. These findings were taken from focus group responses in most cases.
Andrews et al said about the results, “Although patients and clinicians often presume that symptoms, such as nocturia and pain, as well as psychological symptoms, such as worries, fears, and mood disorders, contribute to insomnia, the converse may also be true.”
By jeremyc | November 29, 2013
A large-scale cohort study in the US suggests that opioid use among obese patients increases during the year after bariatric surgery. This was despite the fact that overall opioid usage prevalence declined after surgery. The researchers associated with study found that the mean daily dosage increased even though overall usage decreased. This suggests the need for better post-surgery pain management.
The study was done by Marsha Raebel and colleagues from the Institute for Health Research, Kaiser Permanente Colorado in Denver. Data on 11,719 obese patients who underwent bariatric surgery over a five-year period was analyzed for this study.
Around 8 percent of the patients used opioid analgesics regularly before surgery. During the first year after surgery, 77 percent of the chronic users continued their usage trend, 20 percent reduced to intermittent usage, and 3 percent stopped altogether. The researchers said, “After surgery, chronic opioid users were dispensed higher potency opioids than before surgery… and opioid use shifted from non-Schedule II to short-acting and long-acting Schedule II opioids.”
According to the researchers, a number of factors contributed to this trend of opioid usage. These trends include a development of tolerance to pain and the effects of opioids, the weight loss achieved after surgery, and the presence of chronic pain and/or depression.
By jeremyc | November 28, 2013
A UK survey revealed that one out of six patients in the country experience severe pain during the week after their surgery. This was seen even in patients who underwent minor procedures. The findings of this study showed that healthcare professionals need to be more aware and analgesic strategies need to improve.
The study was done by Rod Taylor and colleagues from the University of Exeter, UK. Data on 228 patients from the Royal London Hospital for orthopedic or general surgery was analyzed. Around 39 percent of these surgeries were major and the rest were minor. The health-related quality of life (HRQoL) before and a week after surgery was analyzed. Pain levels were assessed 24 hours after and seven days after surgery.
On analysis, the researcher found that HRQoL was low before surgery with a mean index of 0.57. In comparison, the average value is 0.85 among the UK general population. Pain severity improved between the 24-hour and seven-day period. On further analysis, a negative correlation was found between severity of pain and HRQoL. Therefore, patients with greater pain levels had a poorer QoL and vice versa. “Acute postoperative pain therefore negatively impacts on both patients’ physical and mental well-being,” the researchers said.
Taylor et al concluded, “That severe pain is seen to continue in a proportion of patients, even with minor surgery, and continues following return to home, needs to be taken into account by healthcare staff responsible for hospital discharge and providing ongoing community-based care.”
By jeremyc | November 27, 2013
Researchers associated with a recent study suggest that ambulatory blood pressure monitoring (ABPM) can be used to monitor the cardiovascular (CV) complications risk in patients with diabetes type 2. The study was done by Gil Salles and colleagues from the University Hospital Clementino Frago Filho in Rio de Janeiro, Brazil.
Salles et al said, “ABPM provides more valuable information regarding cardiovascular risk stratification than office BPs and should be performed, if possible, in every high-risk type 2 diabetic patient.” They are part of the Rio de Janeiro Type 2 Diabetes Cohort Study, and the first findings were just reported by the team recently.
The study involved 565 diabetes patients with a high risk of cardiovascular disease. They were assessed using conventional BP monitoring methods and ABPM for an average of 5.75 years. Follow-ups were held around three to four times per year. The researchers found that 15.6 percent (88 patients) experienced a cardiovascular event. A total of 38 out of this group died due to CV-related causes.
“After adjustments for cardiovascular risk factors, clinic SBP [systolic blood pressure] and DBPs [diastolic blood pressures] were predictive of the composite endpoint but not of all-cause mortality,” said the researchers. They added, “[However,] all ambulatory BP components were predictors of both endpoints.”
The researchers saw that ABPM predicted risk of CV at lower pressure levels than clinic-derived measurements. ABPM also improved risk stratification of CV events over the follow-up period but further BP monitoring did not improve prediction of risk.
By jeremyc | November 26, 2013
A recent study suggests that financial interest may be driving urologists in the US to recommend intensity-modulated radiotherapy (IMRT) for prostate cancer patients. The study involved analyzing Medicare insurance claims data and was led by Jean Mitchel from Georgetown University, Washington, DC.
On analyzing the claims data, Mitchel found that there was increase in IMRT uptake between 2005 and 2010, and it was only seen in urologists who referred their patients to self-owned IMRT services. At the same time, no increase in uptake was found in urologists who did not run such services. Mitchel wrote in her report, “[T]his study shows that men treated by self-referring urologists, as compared with men treated by non-self-referring urologists, are much more likely to undergo IMRT, a treatment with a high reimbursement rate, rather than less expensive options, despite evidence that all treatments yield similar outcomes.”
Data on men being treated for non-metastatic prostate cancer in 35 private practices with self-referral arrangements was compared with 35 other private practices with no such arrangements. Mitchel found that the rates of IMRT referrals increased from 13.1 percent to 32.3 percent. Rates of alternate treatment methods like brachytherapy and androgen-deprivation therapy fell from 18.6 to 5.6 percent and 16.5 to 8.4 percent respectively.
In comparison, the rates of IMRT referrals in non-self-referring clinics did not change significantly. The rates of alternate therapies also remained unchanged. Mitchel said that allowing self-referring contributed to this trend, despite evidence that suggests IMRT is no more effective than the other therapies.
By jeremyc | November 25, 2013
A study done in Massachusetts aimed to see how a workplace smoking ban affected secondhand smoke exposure among workers. The researchers associated with this study found that the percentage of reports of smoke exposure on the job fell between the years 2003 and 2010.
Despite the positive results, the researchers found male, non-white, and young workers had higher exposure rates to secondhand smoke than the rest of the worker population. The study was led by Kathleen Fitzsimmons, MP, from the Massachusetts Department of Public Health. The state had ruled enclosed workplaces with one or more employees as smoke-free zones in 2004.
The researchers used data from the Massachusetts Behavioral Risk Factor Surveillance System (MBRFSS) during the years from 2003 to 2010. Participants in the MBRFSS were asked about environmental tobacco smoke exposure at work. The researchers used this data to estimate exposure to secondhand tobacco smoke in the workplace for different genders, age groups, occupations, and ethnicities.
On analysis, the researchers found that secondhand smoke exposure among workers on average had dropped from 8.0 percent in 2003 to 5.4 percent in 2010. The 2010 data revealed that certain groups of workers were more exposed to secondhand smoke than others. Around 37.4, 22.6, and 19.8 percent of installation/maintenance/repair, construction/extraction, and transportation/material moving workers were exposed to secondhand smoke, respectively.
The researchers concluded, “Certain occupation groups still have exceptionally high exposure prevalence, which raises questions about the role of employers and public health in further protecting workers from this hazard.”