Doug Brunk

PALM SPRINGS, CALIF. — Women who do not participate in routine screening programs may prefer self-testing for human papillomavirus with a tampon or cotton swab over testing administered by a physician, Dr. Robert P. Edwards reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“This is a feasible approach to use for women not currently participating in screening,” Dr. Edwards, the study's lead author, said later in an interview. “The concept of the study was to try to evaluate women who are not currently participating in screening, to see if there is some way we can identify women who might need extra resources to get them into a physician's office.

“For instance, elderly black women over the age of 65 have about six to seven times the incidence of cervical cancer compared with the remainder of the population. It's largely because they're not participating in any screening programs.”

For the study, 171 women aged 18 years and older with an abnormal referral Pap smear were recruited on referral to the colposcopy clinic at the University of Louisville (Ky.). Women who had a prior hysterectomy were excluded from the study, as were those who were pregnant, were taking corticosteroids, were HIV positive, or were taking immunosuppressants.

Study participants performed HPV-DNA self-sampling by using a vaginal swab first and then a vaginal tampon. Then they filled out a questionnaire that asked them about the acceptability of each method compared with previous screening experiences.

A physician then performed a Pap smear and colposcopy and researchers collected data on the sensitivity, specificity, predictive power, and overall test efficiency of each of the three collection methods. The colposcopy results were used as the preferred method, said Dr. Edwards, professor of obstetrics and gynecology at the University of Pittsburgh.

“We were looking to see how well the tests would hold up against physician-directed HPV testing in a population where we knew there would be disease,” he said.

Colposcopy biopsy confirmed that 16% of patients had cervical intraepithelial neoplasia (CIN) 2 and 3; 24% had CIN 1; 1% had cervical cancer, 26% had a normal biopsy, 20% had inflammation, and the rest did not have any cervical biopsies done due to a negative colposcopy.

The researchers found that the tampon collection method was 66% sensitive, 62% specific, and had a positive predictive value of 60% and an overall test efficiency rate of 64%.

The swab collection method was 55% sensitive, 63% specific, and had a positive predictive value of 62% and an overall test efficiency of 63%.

Meanwhile, the physician-collected method was 90% sensitive, 43% specific, had a positive predictive value of 58%, and an overall test efficiency of 65%.

Dr. Edwards says he was surprised that the self-sampling methods were generally more specific than the physician-collected method.

“I would have expected the physician test that's taken directly from the cervix would perform better in that regard,” he said. “That may just be an aberrancy of this particular study.”

He said he was also surprised that 51% of patients preferred self-sampling with a swab while 46% preferred self-sampling with a tampon. “We picked the tampon because we figured women would feel more comfortable inserting that into the vagina,” he said. “But in actuality the swab was just as acceptable.”

The tampon did produce a 10-fold higher cell yield compared with the swab.

Most women (70%) indicated they would prefer self-collection for their next screening.

The study was funded by the James Graham Brown Cancer Center at the University of Louisville.

PALM SPRINGS, CALIF. — Women who do not participate in routine screening programs may prefer self-testing for human papillomavirus with a tampon or cotton swab over testing administered by a physician, Dr. Robert P. Edwards reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“This is a feasible approach to use for women not currently participating in screening,” Dr. Edwards, the study's lead author, said later in an interview. “The concept of the study was to try to evaluate women who are not currently participating in screening, to see if there is some way we can identify women who might need extra resources to get them into a physician's office.

“For instance, elderly black women over the age of 65 have about six to seven times the incidence of cervical cancer compared with the remainder of the population. It's largely because they're not participating in any screening programs.”

For the study, 171 women aged 18 years and older with an abnormal referral Pap smear were recruited on referral to the colposcopy clinic at the University of Louisville (Ky.). Women who had a prior hysterectomy were excluded from the study, as were those who were pregnant, were taking corticosteroids, were HIV positive, or were taking immunosuppressants.

Study participants performed HPV-DNA self-sampling by using a vaginal swab first and then a vaginal tampon. Then they filled out a questionnaire that asked them about the acceptability of each method compared with previous screening experiences.

A physician then performed a Pap smear and colposcopy and researchers collected data on the sensitivity, specificity, predictive power, and overall test efficiency of each of the three collection methods. The colposcopy results were used as the preferred method, said Dr. Edwards, professor of obstetrics and gynecology at the University of Pittsburgh.

“We were looking to see how well the tests would hold up against physician-directed HPV testing in a population where we knew there would be disease,” he said.

Colposcopy biopsy confirmed that 16% of patients had cervical intraepithelial neoplasia (CIN) 2 and 3; 24% had CIN 1; 1% had cervical cancer, 26% had a normal biopsy, 20% had inflammation, and the rest did not have any cervical biopsies done due to a negative colposcopy.

The researchers found that the tampon collection method was 66% sensitive, 62% specific, and had a positive predictive value of 60% and an overall test efficiency rate of 64%.

The swab collection method was 55% sensitive, 63% specific, and had a positive predictive value of 62% and an overall test efficiency of 63%.

Meanwhile, the physician-collected method was 90% sensitive, 43% specific, had a positive predictive value of 58%, and an overall test efficiency of 65%.

Dr. Edwards says he was surprised that the self-sampling methods were generally more specific than the physician-collected method.

“I would have expected the physician test that's taken directly from the cervix would perform better in that regard,” he said. “That may just be an aberrancy of this particular study.”

He said he was also surprised that 51% of patients preferred self-sampling with a swab while 46% preferred self-sampling with a tampon. “We picked the tampon because we figured women would feel more comfortable inserting that into the vagina,” he said. “But in actuality the swab was just as acceptable.”

The tampon did produce a 10-fold higher cell yield compared with the swab.

Most women (70%) indicated they would prefer self-collection for their next screening.

The study was funded by the James Graham Brown Cancer Center at the University of Louisville.

PALM SPRINGS, CALIF. — Women who do not participate in routine screening programs may prefer self-testing for human papillomavirus with a tampon or cotton swab over testing administered by a physician, Dr. Robert P. Edwards reported in a poster session at the annual meeting of the Society of Gynecologic Oncologists.

“This is a feasible approach to use for women not currently participating in screening,” Dr. Edwards, the study's lead author, said later in an interview. “The concept of the study was to try to evaluate women who are not currently participating in screening, to see if there is some way we can identify women who might need extra resources to get them into a physician's office.

“For instance, elderly black women over the age of 65 have about six to seven times the incidence of cervical cancer compared with the remainder of the population. It's largely because they're not participating in any screening programs.”

For the study, 171 women aged 18 years and older with an abnormal referral Pap smear were recruited on referral to the colposcopy clinic at the University of Louisville (Ky.). Women who had a prior hysterectomy were excluded from the study, as were those who were pregnant, were taking corticosteroids, were HIV positive, or were taking immunosuppressants.

Study participants performed HPV-DNA self-sampling by using a vaginal swab first and then a vaginal tampon. Then they filled out a questionnaire that asked them about the acceptability of each method compared with previous screening experiences.

A physician then performed a Pap smear and colposcopy and researchers collected data on the sensitivity, specificity, predictive power, and overall test efficiency of each of the three collection methods. The colposcopy results were used as the preferred method, said Dr. Edwards, professor of obstetrics and gynecology at the University of Pittsburgh.

“We were looking to see how well the tests would hold up against physician-directed HPV testing in a population where we knew there would be disease,” he said.

Colposcopy biopsy confirmed that 16% of patients had cervical intraepithelial neoplasia (CIN) 2 and 3; 24% had CIN 1; 1% had cervical cancer, 26% had a normal biopsy, 20% had inflammation, and the rest did not have any cervical biopsies done due to a negative colposcopy.

The researchers found that the tampon collection method was 66% sensitive, 62% specific, and had a positive predictive value of 60% and an overall test efficiency rate of 64%.

The swab collection method was 55% sensitive, 63% specific, and had a positive predictive value of 62% and an overall test efficiency of 63%.

Meanwhile, the physician-collected method was 90% sensitive, 43% specific, had a positive predictive value of 58%, and an overall test efficiency of 65%.

Dr. Edwards says he was surprised that the self-sampling methods were generally more specific than the physician-collected method.

“I would have expected the physician test that's taken directly from the cervix would perform better in that regard,” he said. “That may just be an aberrancy of this particular study.”

He said he was also surprised that 51% of patients preferred self-sampling with a swab while 46% preferred self-sampling with a tampon. “We picked the tampon because we figured women would feel more comfortable inserting that into the vagina,” he said. “But in actuality the swab was just as acceptable.”

The tampon did produce a 10-fold higher cell yield compared with the swab.

Most women (70%) indicated they would prefer self-collection for their next screening.

The study was funded by the James Graham Brown Cancer Center at the University of Louisville.

SAN DIEGO — Medical students perceive the specialty of adult neurology as offering only limited treatment options, with poor patient outcomes. In addition, they find neuropathophysiology to be complicated and hard to understand, judging from the findings of a survey of 113 third-year medical students, only 2 of whom had settled on adult neurology as the specialty they planned to pursue.

“Also, [respondents] didn't feel there [would be] a lot of technological advances in the future of neurology,” said Shara D. Steiner, reporting in a poster session at the annual meeting of the American Academy of Neurology.

Survey respondents rated the quality of their neurologic education as suboptimal in neurogenetics, neuropsychiatry, and the neurologic exam. “The didactic component of the first 2 years of medical school needs to be improved in the area of neurology, neuroscience, and neurophysiology,” she said.

Overall, the most important factor that influences the attitudes of third-year medical students toward a career in adult neurology is the perceived quality of clinical neurology teaching. The second most important factor is the perceived knowledge, professionalism, and enthusiasm of neurology professors, said Ms. Steiner, a third-year medical student at Nova Southeastern University, Fort Lauderdale, Fla.

“Medical students will be most interested in becoming a neurologist if their education and their clinical experience really fosters a spark,” she said in an interview.

The finding is important as the field seeks to attract junior medical students. “Every year there are residency spots in adult neurology that go unfilled,” she noted.

For the study, 113 third-year medical students from seven medical schools were surveyed before the start of their neurology clerkship. A 45-item questionnaire developed by Ms. Steiner and her associates assessed the students' attitudes toward adult neurology and asked them to rank the factors that were most influential in their choosing or excluding the field as a career choice.

Respondents included medical students from the University of Miami, Tufts University, New York Medical College, Tulane University, Ross University, Nova Southeastern, and the New York College of Osteopathic Medicine. The mean age of respondents was 26 years, and 57% were male.

The most common intended career choices reported by respondents were pediatrics (14), a subspecialty (9), internal medicine (7), and family practice (5). Of the 113 students surveyed, 52 were undecided.

SAN DIEGO — Medical students perceive the specialty of adult neurology as offering only limited treatment options, with poor patient outcomes. In addition, they find neuropathophysiology to be complicated and hard to understand, judging from the findings of a survey of 113 third-year medical students, only 2 of whom had settled on adult neurology as the specialty they planned to pursue.

“Also, [respondents] didn't feel there [would be] a lot of technological advances in the future of neurology,” said Shara D. Steiner, reporting in a poster session at the annual meeting of the American Academy of Neurology.

Survey respondents rated the quality of their neurologic education as suboptimal in neurogenetics, neuropsychiatry, and the neurologic exam. “The didactic component of the first 2 years of medical school needs to be improved in the area of neurology, neuroscience, and neurophysiology,” she said.

Overall, the most important factor that influences the attitudes of third-year medical students toward a career in adult neurology is the perceived quality of clinical neurology teaching. The second most important factor is the perceived knowledge, professionalism, and enthusiasm of neurology professors, said Ms. Steiner, a third-year medical student at Nova Southeastern University, Fort Lauderdale, Fla.

“Medical students will be most interested in becoming a neurologist if their education and their clinical experience really fosters a spark,” she said in an interview.

The finding is important as the field seeks to attract junior medical students. “Every year there are residency spots in adult neurology that go unfilled,” she noted.

For the study, 113 third-year medical students from seven medical schools were surveyed before the start of their neurology clerkship. A 45-item questionnaire developed by Ms. Steiner and her associates assessed the students' attitudes toward adult neurology and asked them to rank the factors that were most influential in their choosing or excluding the field as a career choice.

Respondents included medical students from the University of Miami, Tufts University, New York Medical College, Tulane University, Ross University, Nova Southeastern, and the New York College of Osteopathic Medicine. The mean age of respondents was 26 years, and 57% were male.

The most common intended career choices reported by respondents were pediatrics (14), a subspecialty (9), internal medicine (7), and family practice (5). Of the 113 students surveyed, 52 were undecided.

SAN DIEGO — Medical students perceive the specialty of adult neurology as offering only limited treatment options, with poor patient outcomes. In addition, they find neuropathophysiology to be complicated and hard to understand, judging from the findings of a survey of 113 third-year medical students, only 2 of whom had settled on adult neurology as the specialty they planned to pursue.

“Also, [respondents] didn't feel there [would be] a lot of technological advances in the future of neurology,” said Shara D. Steiner, reporting in a poster session at the annual meeting of the American Academy of Neurology.

Survey respondents rated the quality of their neurologic education as suboptimal in neurogenetics, neuropsychiatry, and the neurologic exam. “The didactic component of the first 2 years of medical school needs to be improved in the area of neurology, neuroscience, and neurophysiology,” she said.

Overall, the most important factor that influences the attitudes of third-year medical students toward a career in adult neurology is the perceived quality of clinical neurology teaching. The second most important factor is the perceived knowledge, professionalism, and enthusiasm of neurology professors, said Ms. Steiner, a third-year medical student at Nova Southeastern University, Fort Lauderdale, Fla.

“Medical students will be most interested in becoming a neurologist if their education and their clinical experience really fosters a spark,” she said in an interview.

The finding is important as the field seeks to attract junior medical students. “Every year there are residency spots in adult neurology that go unfilled,” she noted.

For the study, 113 third-year medical students from seven medical schools were surveyed before the start of their neurology clerkship. A 45-item questionnaire developed by Ms. Steiner and her associates assessed the students' attitudes toward adult neurology and asked them to rank the factors that were most influential in their choosing or excluding the field as a career choice.

Respondents included medical students from the University of Miami, Tufts University, New York Medical College, Tulane University, Ross University, Nova Southeastern, and the New York College of Osteopathic Medicine. The mean age of respondents was 26 years, and 57% were male.

The most common intended career choices reported by respondents were pediatrics (14), a subspecialty (9), internal medicine (7), and family practice (5). Of the 113 students surveyed, 52 were undecided.

SAN DIEGO — Parkinson's disease patients who have undergone subthalamic nucleus deep brain stimulation have higher rates of completed and attempted suicide than do others with the disease, Dr. Valerie Voon reported at the annual meeting of the American Academy of Neurology.

The rate of completed suicides following deep brain stimulation (DBS) for Parkinson's disease (PD) was found to be 0.4% and the rate of attempted suicides 0.9% in the largest multicenter study of its kind, said Dr. Voon, a psychiatrist with the National Institute of Neurological Disorders and Stroke, Bethesda, Md.

The researchers noted that the suicide rate among PD patients within the first year after undergoing subthalamic DBS was 11− 37 times higher than the suicide rate in the general population, based on World Health Organization data. The rate was 4–13 times higher in postoperative year 2 and dropped to baseline in postoperative years 3 and 4.

The rate of suicide is 10 times lower in PD patients who have not undergone DBS, when compared with the World Health Organization's general population data, she added.

Dr. Voon and her associates surveyed 75 movement disorders centers in North America and Europe to locate PD patients who underwent subthalamic nucleus DBS and subsequently attempted or completed suicide. Participating centers had published medical literature on DBS and had operated on more than 100 DBS patients.

Of the 75 centers, 55 responded and provided data on 5,255 PD patients who underwent subthalamic nucleus DBS. Following DBS, 22 of the patients completed suicide (0.4%) between 1 month and 4 years.

The researchers also found that 47 patients attempted suicide (0.9%). The attempted suicides took place between approximately 1 week and 8 years following DBS.

Preoperatively, three completed and three attempted suicides were reported. These patients were on DBS wait lists.

“The highest risk period is in the first 10 months to 1.5 years” after DBS, she said. “At 10 months time, 50% of the events had already occurred. At 17 months, 75% of the events had occurred.”

Logistic regression analysis based on a study of 70 controls revealed that the following factors were independently associated with an increased risk of suicide: past history of impulse control disorder or substance abuse, being single, or having postoperative depression.

Suicide “has significant implications and it's potentially quite preventable,” said Dr. Voon, “so patients and families should be aware of this risk.”

SAN DIEGO — Parkinson's disease patients who have undergone subthalamic nucleus deep brain stimulation have higher rates of completed and attempted suicide than do others with the disease, Dr. Valerie Voon reported at the annual meeting of the American Academy of Neurology.

The rate of completed suicides following deep brain stimulation (DBS) for Parkinson's disease (PD) was found to be 0.4% and the rate of attempted suicides 0.9% in the largest multicenter study of its kind, said Dr. Voon, a psychiatrist with the National Institute of Neurological Disorders and Stroke, Bethesda, Md.

The researchers noted that the suicide rate among PD patients within the first year after undergoing subthalamic DBS was 11− 37 times higher than the suicide rate in the general population, based on World Health Organization data. The rate was 4–13 times higher in postoperative year 2 and dropped to baseline in postoperative years 3 and 4.

The rate of suicide is 10 times lower in PD patients who have not undergone DBS, when compared with the World Health Organization's general population data, she added.

Dr. Voon and her associates surveyed 75 movement disorders centers in North America and Europe to locate PD patients who underwent subthalamic nucleus DBS and subsequently attempted or completed suicide. Participating centers had published medical literature on DBS and had operated on more than 100 DBS patients.

Of the 75 centers, 55 responded and provided data on 5,255 PD patients who underwent subthalamic nucleus DBS. Following DBS, 22 of the patients completed suicide (0.4%) between 1 month and 4 years.

The researchers also found that 47 patients attempted suicide (0.9%). The attempted suicides took place between approximately 1 week and 8 years following DBS.

Preoperatively, three completed and three attempted suicides were reported. These patients were on DBS wait lists.

“The highest risk period is in the first 10 months to 1.5 years” after DBS, she said. “At 10 months time, 50% of the events had already occurred. At 17 months, 75% of the events had occurred.”

Logistic regression analysis based on a study of 70 controls revealed that the following factors were independently associated with an increased risk of suicide: past history of impulse control disorder or substance abuse, being single, or having postoperative depression.

Suicide “has significant implications and it's potentially quite preventable,” said Dr. Voon, “so patients and families should be aware of this risk.”

SAN DIEGO — Parkinson's disease patients who have undergone subthalamic nucleus deep brain stimulation have higher rates of completed and attempted suicide than do others with the disease, Dr. Valerie Voon reported at the annual meeting of the American Academy of Neurology.

The rate of completed suicides following deep brain stimulation (DBS) for Parkinson's disease (PD) was found to be 0.4% and the rate of attempted suicides 0.9% in the largest multicenter study of its kind, said Dr. Voon, a psychiatrist with the National Institute of Neurological Disorders and Stroke, Bethesda, Md.

The researchers noted that the suicide rate among PD patients within the first year after undergoing subthalamic DBS was 11− 37 times higher than the suicide rate in the general population, based on World Health Organization data. The rate was 4–13 times higher in postoperative year 2 and dropped to baseline in postoperative years 3 and 4.

The rate of suicide is 10 times lower in PD patients who have not undergone DBS, when compared with the World Health Organization's general population data, she added.

Dr. Voon and her associates surveyed 75 movement disorders centers in North America and Europe to locate PD patients who underwent subthalamic nucleus DBS and subsequently attempted or completed suicide. Participating centers had published medical literature on DBS and had operated on more than 100 DBS patients.

Of the 75 centers, 55 responded and provided data on 5,255 PD patients who underwent subthalamic nucleus DBS. Following DBS, 22 of the patients completed suicide (0.4%) between 1 month and 4 years.

The researchers also found that 47 patients attempted suicide (0.9%). The attempted suicides took place between approximately 1 week and 8 years following DBS.

Preoperatively, three completed and three attempted suicides were reported. These patients were on DBS wait lists.

“The highest risk period is in the first 10 months to 1.5 years” after DBS, she said. “At 10 months time, 50% of the events had already occurred. At 17 months, 75% of the events had occurred.”

Logistic regression analysis based on a study of 70 controls revealed that the following factors were independently associated with an increased risk of suicide: past history of impulse control disorder or substance abuse, being single, or having postoperative depression.

Suicide “has significant implications and it's potentially quite preventable,” said Dr. Voon, “so patients and families should be aware of this risk.”

SAN DIEGO — So-called zero-mortality hospitals subsequently experience mortality rates that are similar to or higher than those of other hospitals, Dr. Justin B. Dimick reported at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

To determine whether zero-mortality hospitals actually achieved better results than did other hospitals “or were just lucky,” Dr. Dimick and his associates obtained national Medicare data for 1997–1999 on five high-risk operations that are widely included in quality improvement measures and programs: coronary artery bypass grafting; abdominal aortic aneurysm repair; and resections for colon, lung, and pancreatic cancers. For each procedure, the researchers defined zero-mortality hospitals as those with no inpatient or 30-day deaths over the 3-year period.

The investigators compared the mortality rates of the zero-mortality hospitals for the subsequent year (2000) with the mortality rates at other hospitals.

No significant difference in mortality was observed between zero-mortality hospitals and the other hospitals for the following four procedures: coronary artery bypass surgery (4.0% zero-mortality hospitals vs. 5.0% other hospitals), abdominal aortic aneurysm repair (6.3% vs. 5.8%, respectively), colon cancer resection (6.0% vs. 6.6%, respectively), and lobectomy for lung cancer (5.1% vs. 5.3%, respectively). In pancreatic cancer resection, however, the mortality rate was significantly worse for zero-mortality hospitals than it was for other hospitals (11.2% vs. 8.7%, respectively).

The researchers also observed that zero-mortality hospitals had fewer cases of all five operations than the other hospitals had.

“More attention should be paid to sample size in quality measurement,” recommended Dr. Dimick of the University of Michigan, Ann Arbor. He also called for hospital quality measures that “are more reliable and precise.”

The findings suggest that in deciding where to have surgery, patients “cannot consider a reported mortality of zero as a reliable indicator of future performance,” said Dr. Dimick.

Right now the Agency for Healthcare Research and Quality is using operative mortality rates as quality measures. These are being published on Web sites, despite data showing [such measures] may not be useful,” he said.

SAN DIEGO — So-called zero-mortality hospitals subsequently experience mortality rates that are similar to or higher than those of other hospitals, Dr. Justin B. Dimick reported at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

To determine whether zero-mortality hospitals actually achieved better results than did other hospitals “or were just lucky,” Dr. Dimick and his associates obtained national Medicare data for 1997–1999 on five high-risk operations that are widely included in quality improvement measures and programs: coronary artery bypass grafting; abdominal aortic aneurysm repair; and resections for colon, lung, and pancreatic cancers. For each procedure, the researchers defined zero-mortality hospitals as those with no inpatient or 30-day deaths over the 3-year period.

The investigators compared the mortality rates of the zero-mortality hospitals for the subsequent year (2000) with the mortality rates at other hospitals.

No significant difference in mortality was observed between zero-mortality hospitals and the other hospitals for the following four procedures: coronary artery bypass surgery (4.0% zero-mortality hospitals vs. 5.0% other hospitals), abdominal aortic aneurysm repair (6.3% vs. 5.8%, respectively), colon cancer resection (6.0% vs. 6.6%, respectively), and lobectomy for lung cancer (5.1% vs. 5.3%, respectively). In pancreatic cancer resection, however, the mortality rate was significantly worse for zero-mortality hospitals than it was for other hospitals (11.2% vs. 8.7%, respectively).

The researchers also observed that zero-mortality hospitals had fewer cases of all five operations than the other hospitals had.

“More attention should be paid to sample size in quality measurement,” recommended Dr. Dimick of the University of Michigan, Ann Arbor. He also called for hospital quality measures that “are more reliable and precise.”

The findings suggest that in deciding where to have surgery, patients “cannot consider a reported mortality of zero as a reliable indicator of future performance,” said Dr. Dimick.

Right now the Agency for Healthcare Research and Quality is using operative mortality rates as quality measures. These are being published on Web sites, despite data showing [such measures] may not be useful,” he said.

SAN DIEGO — So-called zero-mortality hospitals subsequently experience mortality rates that are similar to or higher than those of other hospitals, Dr. Justin B. Dimick reported at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

To determine whether zero-mortality hospitals actually achieved better results than did other hospitals “or were just lucky,” Dr. Dimick and his associates obtained national Medicare data for 1997–1999 on five high-risk operations that are widely included in quality improvement measures and programs: coronary artery bypass grafting; abdominal aortic aneurysm repair; and resections for colon, lung, and pancreatic cancers. For each procedure, the researchers defined zero-mortality hospitals as those with no inpatient or 30-day deaths over the 3-year period.

The investigators compared the mortality rates of the zero-mortality hospitals for the subsequent year (2000) with the mortality rates at other hospitals.

No significant difference in mortality was observed between zero-mortality hospitals and the other hospitals for the following four procedures: coronary artery bypass surgery (4.0% zero-mortality hospitals vs. 5.0% other hospitals), abdominal aortic aneurysm repair (6.3% vs. 5.8%, respectively), colon cancer resection (6.0% vs. 6.6%, respectively), and lobectomy for lung cancer (5.1% vs. 5.3%, respectively). In pancreatic cancer resection, however, the mortality rate was significantly worse for zero-mortality hospitals than it was for other hospitals (11.2% vs. 8.7%, respectively).

The researchers also observed that zero-mortality hospitals had fewer cases of all five operations than the other hospitals had.

“More attention should be paid to sample size in quality measurement,” recommended Dr. Dimick of the University of Michigan, Ann Arbor. He also called for hospital quality measures that “are more reliable and precise.”

The findings suggest that in deciding where to have surgery, patients “cannot consider a reported mortality of zero as a reliable indicator of future performance,” said Dr. Dimick.

Right now the Agency for Healthcare Research and Quality is using operative mortality rates as quality measures. These are being published on Web sites, despite data showing [such measures] may not be useful,” he said.

LA JOLLA, CALIF. – Targeted amino acid therapy shows promise as an intervention for children with behavioral disorders, a group of researchers led by Karyn Purvis, Ph.D., reported in a poster session at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

“Based upon an evaluation of the child's current neurotransmitter levels, targeted amino acid therapy (TAAT) can be used to provide nutritional support for the production of neurotransmitters that are deficient in the child's central nervous system,” the researchers wrote in their poster. “We hypothesized that by enhancing the production of deficient neurotransmitters, TAAT can lead to changes both in children's neurotransmitter levels and their behavior.”

Dr. Purvis of Texas Christian University, Fort Worth, and her associates studied 78 children with an average age of 10 years. The children were recruited through local support groups for adoptive parents and were considered at risk for serious behavior disorders.

Forty-four children were randomly assigned to the treatment group, and 34 served as controls. Treatment consisted of amino acid supplements (made and provided by NeuroScience Inc.) that are designed to provide nutritional support for serotonin and γ-aminobutyric acid (GABA) production. At baseline and 2 months, parents completed Achenbach's Child Behavior Checklist (CBCL), and urine samples from the children were assayed for epinephrine, norepinephrine, dopamine, serotonin, GABA, glutamate, pulseless electrical activity (PEA), and histamine.

At the 2-month assessment, children in the treatment group showed significant improvement, compared with controls, in half the assays studied (epinephrine, serotonin, GABA, and PEA) and on 6 of 11 CBCL subscales: anxiety/depression, thought problems, attention problems, aggressive behavior, other problems, and externalizing behaviors.

More research is needed, but this initial study suggests that TAAT is a promising avenue, the researchers concluded at the meeting, cosponsored by the University of California, San Diego.

LA JOLLA, CALIF. – Targeted amino acid therapy shows promise as an intervention for children with behavioral disorders, a group of researchers led by Karyn Purvis, Ph.D., reported in a poster session at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

“Based upon an evaluation of the child's current neurotransmitter levels, targeted amino acid therapy (TAAT) can be used to provide nutritional support for the production of neurotransmitters that are deficient in the child's central nervous system,” the researchers wrote in their poster. “We hypothesized that by enhancing the production of deficient neurotransmitters, TAAT can lead to changes both in children's neurotransmitter levels and their behavior.”

Dr. Purvis of Texas Christian University, Fort Worth, and her associates studied 78 children with an average age of 10 years. The children were recruited through local support groups for adoptive parents and were considered at risk for serious behavior disorders.

Forty-four children were randomly assigned to the treatment group, and 34 served as controls. Treatment consisted of amino acid supplements (made and provided by NeuroScience Inc.) that are designed to provide nutritional support for serotonin and γ-aminobutyric acid (GABA) production. At baseline and 2 months, parents completed Achenbach's Child Behavior Checklist (CBCL), and urine samples from the children were assayed for epinephrine, norepinephrine, dopamine, serotonin, GABA, glutamate, pulseless electrical activity (PEA), and histamine.

At the 2-month assessment, children in the treatment group showed significant improvement, compared with controls, in half the assays studied (epinephrine, serotonin, GABA, and PEA) and on 6 of 11 CBCL subscales: anxiety/depression, thought problems, attention problems, aggressive behavior, other problems, and externalizing behaviors.

More research is needed, but this initial study suggests that TAAT is a promising avenue, the researchers concluded at the meeting, cosponsored by the University of California, San Diego.

LA JOLLA, CALIF. – Targeted amino acid therapy shows promise as an intervention for children with behavioral disorders, a group of researchers led by Karyn Purvis, Ph.D., reported in a poster session at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

“Based upon an evaluation of the child's current neurotransmitter levels, targeted amino acid therapy (TAAT) can be used to provide nutritional support for the production of neurotransmitters that are deficient in the child's central nervous system,” the researchers wrote in their poster. “We hypothesized that by enhancing the production of deficient neurotransmitters, TAAT can lead to changes both in children's neurotransmitter levels and their behavior.”

Dr. Purvis of Texas Christian University, Fort Worth, and her associates studied 78 children with an average age of 10 years. The children were recruited through local support groups for adoptive parents and were considered at risk for serious behavior disorders.

Forty-four children were randomly assigned to the treatment group, and 34 served as controls. Treatment consisted of amino acid supplements (made and provided by NeuroScience Inc.) that are designed to provide nutritional support for serotonin and γ-aminobutyric acid (GABA) production. At baseline and 2 months, parents completed Achenbach's Child Behavior Checklist (CBCL), and urine samples from the children were assayed for epinephrine, norepinephrine, dopamine, serotonin, GABA, glutamate, pulseless electrical activity (PEA), and histamine.

At the 2-month assessment, children in the treatment group showed significant improvement, compared with controls, in half the assays studied (epinephrine, serotonin, GABA, and PEA) and on 6 of 11 CBCL subscales: anxiety/depression, thought problems, attention problems, aggressive behavior, other problems, and externalizing behaviors.

More research is needed, but this initial study suggests that TAAT is a promising avenue, the researchers concluded at the meeting, cosponsored by the University of California, San Diego.

SAN DIEGO — Restricted patellar mobility in patients with anterior knee pain is associated with chondral damage in the patellofemoral compartment, results from a large study demonstrated.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness, Dr. J. Richard Steadman reported at a symposium sponsored by the International Cartilage Repair Society.

Many causes for patellar immobility exist, including compartmentalization by plica, suprapatellar scarring, and anterior interval contracture. “If you look at the patellar tendon and its relationship to the tibia going into flexion you'll find that patellar tendon actually separates from the tibia,” explained Dr. Steadman, of the Steadman Hawkins Research Foundation, Vail, Colo. “So if you have a scarring … between the patellar tendon and the tibia, you've eliminated the slack in the joint that allows you to have noncompressed cartilage as you go through a range of motion.”

Preoperatively, he and his associates subjectively measured and documented patellar tightness in the superior, inferior, medial, or lateral directions in 410 knees between November 2004 and November 2005. At surgery, the researchers collected data on knee pathology and documented chondral defects in all compartments of the knee. Grade 3 or 4 defects on the Outerbridge classification system were considered severe chondral damage.

Slightly more than half of the study participants (52%) were female and their average age was 44 years.

Dr. Steadman reported that preoperatively, 41% of patients had patellar tightness in at least one direction, 24% had patellar tightness in all four directions, 9% had inferior and superior tightness only, and 3% had medial and lateral tightness only. At surgery, 40% of patients had severe chondral damage of the patellofemoral compartment.

In addition, 54% of knees with patellar tightness had severe patellofemoral chondral damage while only 29% without patellar tightness had severe patellofemoral chondral damage.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness. The highest odds of severe patellofemoral defects were associated with superior tightness (3.0) and inferior tightness (2.4).

SAN DIEGO — Restricted patellar mobility in patients with anterior knee pain is associated with chondral damage in the patellofemoral compartment, results from a large study demonstrated.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness, Dr. J. Richard Steadman reported at a symposium sponsored by the International Cartilage Repair Society.

Many causes for patellar immobility exist, including compartmentalization by plica, suprapatellar scarring, and anterior interval contracture. “If you look at the patellar tendon and its relationship to the tibia going into flexion you'll find that patellar tendon actually separates from the tibia,” explained Dr. Steadman, of the Steadman Hawkins Research Foundation, Vail, Colo. “So if you have a scarring … between the patellar tendon and the tibia, you've eliminated the slack in the joint that allows you to have noncompressed cartilage as you go through a range of motion.”

Preoperatively, he and his associates subjectively measured and documented patellar tightness in the superior, inferior, medial, or lateral directions in 410 knees between November 2004 and November 2005. At surgery, the researchers collected data on knee pathology and documented chondral defects in all compartments of the knee. Grade 3 or 4 defects on the Outerbridge classification system were considered severe chondral damage.

Slightly more than half of the study participants (52%) were female and their average age was 44 years.

Dr. Steadman reported that preoperatively, 41% of patients had patellar tightness in at least one direction, 24% had patellar tightness in all four directions, 9% had inferior and superior tightness only, and 3% had medial and lateral tightness only. At surgery, 40% of patients had severe chondral damage of the patellofemoral compartment.

In addition, 54% of knees with patellar tightness had severe patellofemoral chondral damage while only 29% without patellar tightness had severe patellofemoral chondral damage.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness. The highest odds of severe patellofemoral defects were associated with superior tightness (3.0) and inferior tightness (2.4).

SAN DIEGO — Restricted patellar mobility in patients with anterior knee pain is associated with chondral damage in the patellofemoral compartment, results from a large study demonstrated.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness, Dr. J. Richard Steadman reported at a symposium sponsored by the International Cartilage Repair Society.

Many causes for patellar immobility exist, including compartmentalization by plica, suprapatellar scarring, and anterior interval contracture. “If you look at the patellar tendon and its relationship to the tibia going into flexion you'll find that patellar tendon actually separates from the tibia,” explained Dr. Steadman, of the Steadman Hawkins Research Foundation, Vail, Colo. “So if you have a scarring … between the patellar tendon and the tibia, you've eliminated the slack in the joint that allows you to have noncompressed cartilage as you go through a range of motion.”

Preoperatively, he and his associates subjectively measured and documented patellar tightness in the superior, inferior, medial, or lateral directions in 410 knees between November 2004 and November 2005. At surgery, the researchers collected data on knee pathology and documented chondral defects in all compartments of the knee. Grade 3 or 4 defects on the Outerbridge classification system were considered severe chondral damage.

Slightly more than half of the study participants (52%) were female and their average age was 44 years.

Dr. Steadman reported that preoperatively, 41% of patients had patellar tightness in at least one direction, 24% had patellar tightness in all four directions, 9% had inferior and superior tightness only, and 3% had medial and lateral tightness only. At surgery, 40% of patients had severe chondral damage of the patellofemoral compartment.

In addition, 54% of knees with patellar tightness had severe patellofemoral chondral damage while only 29% without patellar tightness had severe patellofemoral chondral damage.

Knees with patellar tightness were three times more likely to have severe patellofemoral damage compared with those without tightness. The highest odds of severe patellofemoral defects were associated with superior tightness (3.0) and inferior tightness (2.4).

LAS VEGAS — There are at least six behavior change strategies physicians can recommend to prevent child and adolescent obesity, Dr. William H. Dietz said at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Reasonable scientific certainty” exists for three of the six strategies, said Dr. Dietz, director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention, Atlanta.

These well-documented strategies are:

▸ Increase physical activity. Emerging evidence regarding the pediatric population suggests that physical activity can reduce obesity-associated comorbidity, particularly glucose intolerance and hyperlipidemia, Dr. Dietz said.

“So if you are obese, inactive, and have elevated triglycerides, increased physical activity will improve your triglyceride level,” he said. “It can also raise your HDL and lower your LDL.”

He added that about 10 years ago, 20% of children walked to school. Today that figure is less than 12%.

▸ Reduce television viewing time. According the Kaiser Family Foundation, 17% of children and adolescents are watching 5 or more hours of television per day.

“Even in the heaviest adolescent computer users, computer time pales by comparison to sedentary [television viewing] time,” Dr. Dietz said. “We have [found] a linear relationship between the amount of television a child watches and the prevalence of overweight.”

▸ Promote breast-feeding. Three metaanalyses in the medical literature have demonstrated that breast-feeding appears to reduce early childhood overweight.

Dr. Dietz defined the next three interventions as “promising. Characteristic of these strategies is that there's no absolute impact for any of them,” he said.

The three promising strategies are:

▸ Increase fruit and vegetable consumption. This dietary factor “appears to have an impact on satiety by virtue of the volume of foods that you consume,” Dr. Dietz explained.

“Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food. Therefore, food of low caloric density that is high [in] water content is more filling,” he said. “However, data is still lacking for the evidence that increasing [intake of] fruits and vegetables helps reduce weight or that people who have an increased fruit and vegetable intake have a lower risk of being obese.”

▸ Reduce soft drink consumption. A number of studies have linked soft drink consumption to increased weight gain. Yet “we don't yet have studies which demonstrate that reduced soft drink intake is a good way to control weight,” Dr. Dietz noted.

▸ Reduce portion size. This strategy “has a very robust impact on food intake,” he said. “The larger the portion an individual is exposed to, the more likely they are to overeat. We don't have good data that control of portion size is an effective way to reduce weight, but it is a logical potential strategy.”

“One of the problems is a lack of consistent messages,” he said. Young people need to hear a message from their physician, and then have that same message reinforced by what they hear in school, in the community, and from their parents.

Awareness of the problem of obesity among children and adolescents in the United States is starting to plateau, he said.

“I don't think we yet have strategies as effective as those which have been employed against tobacco [use]. Per capita cigarette consumption didn't decline because of a single intervention but because of multiple overlapping interventions,” Dr. Dietz said. “I think interventions with respect to obesity are going to be found in the clinical arena as well as in the schools and communities. We need more communication strategies and advocacy on your part.”

'Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food.' DR. DIETZ

LAS VEGAS — There are at least six behavior change strategies physicians can recommend to prevent child and adolescent obesity, Dr. William H. Dietz said at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Reasonable scientific certainty” exists for three of the six strategies, said Dr. Dietz, director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention, Atlanta.

These well-documented strategies are:

▸ Increase physical activity. Emerging evidence regarding the pediatric population suggests that physical activity can reduce obesity-associated comorbidity, particularly glucose intolerance and hyperlipidemia, Dr. Dietz said.

“So if you are obese, inactive, and have elevated triglycerides, increased physical activity will improve your triglyceride level,” he said. “It can also raise your HDL and lower your LDL.”

He added that about 10 years ago, 20% of children walked to school. Today that figure is less than 12%.

▸ Reduce television viewing time. According the Kaiser Family Foundation, 17% of children and adolescents are watching 5 or more hours of television per day.

“Even in the heaviest adolescent computer users, computer time pales by comparison to sedentary [television viewing] time,” Dr. Dietz said. “We have [found] a linear relationship between the amount of television a child watches and the prevalence of overweight.”

▸ Promote breast-feeding. Three metaanalyses in the medical literature have demonstrated that breast-feeding appears to reduce early childhood overweight.

Dr. Dietz defined the next three interventions as “promising. Characteristic of these strategies is that there's no absolute impact for any of them,” he said.

The three promising strategies are:

▸ Increase fruit and vegetable consumption. This dietary factor “appears to have an impact on satiety by virtue of the volume of foods that you consume,” Dr. Dietz explained.

“Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food. Therefore, food of low caloric density that is high [in] water content is more filling,” he said. “However, data is still lacking for the evidence that increasing [intake of] fruits and vegetables helps reduce weight or that people who have an increased fruit and vegetable intake have a lower risk of being obese.”

▸ Reduce soft drink consumption. A number of studies have linked soft drink consumption to increased weight gain. Yet “we don't yet have studies which demonstrate that reduced soft drink intake is a good way to control weight,” Dr. Dietz noted.

▸ Reduce portion size. This strategy “has a very robust impact on food intake,” he said. “The larger the portion an individual is exposed to, the more likely they are to overeat. We don't have good data that control of portion size is an effective way to reduce weight, but it is a logical potential strategy.”

“One of the problems is a lack of consistent messages,” he said. Young people need to hear a message from their physician, and then have that same message reinforced by what they hear in school, in the community, and from their parents.

Awareness of the problem of obesity among children and adolescents in the United States is starting to plateau, he said.

“I don't think we yet have strategies as effective as those which have been employed against tobacco [use]. Per capita cigarette consumption didn't decline because of a single intervention but because of multiple overlapping interventions,” Dr. Dietz said. “I think interventions with respect to obesity are going to be found in the clinical arena as well as in the schools and communities. We need more communication strategies and advocacy on your part.”

'Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food.' DR. DIETZ

LAS VEGAS — There are at least six behavior change strategies physicians can recommend to prevent child and adolescent obesity, Dr. William H. Dietz said at a meeting sponsored by the American Academy of Pediatrics' California Chapters 1, 2, 3, and 4 and the AAP.

“Reasonable scientific certainty” exists for three of the six strategies, said Dr. Dietz, director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention, Atlanta.

These well-documented strategies are:

▸ Increase physical activity. Emerging evidence regarding the pediatric population suggests that physical activity can reduce obesity-associated comorbidity, particularly glucose intolerance and hyperlipidemia, Dr. Dietz said.

“So if you are obese, inactive, and have elevated triglycerides, increased physical activity will improve your triglyceride level,” he said. “It can also raise your HDL and lower your LDL.”

He added that about 10 years ago, 20% of children walked to school. Today that figure is less than 12%.

▸ Reduce television viewing time. According the Kaiser Family Foundation, 17% of children and adolescents are watching 5 or more hours of television per day.

“Even in the heaviest adolescent computer users, computer time pales by comparison to sedentary [television viewing] time,” Dr. Dietz said. “We have [found] a linear relationship between the amount of television a child watches and the prevalence of overweight.”

▸ Promote breast-feeding. Three metaanalyses in the medical literature have demonstrated that breast-feeding appears to reduce early childhood overweight.

Dr. Dietz defined the next three interventions as “promising. Characteristic of these strategies is that there's no absolute impact for any of them,” he said.

The three promising strategies are:

▸ Increase fruit and vegetable consumption. This dietary factor “appears to have an impact on satiety by virtue of the volume of foods that you consume,” Dr. Dietz explained.

“Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food. Therefore, food of low caloric density that is high [in] water content is more filling,” he said. “However, data is still lacking for the evidence that increasing [intake of] fruits and vegetables helps reduce weight or that people who have an increased fruit and vegetable intake have a lower risk of being obese.”

▸ Reduce soft drink consumption. A number of studies have linked soft drink consumption to increased weight gain. Yet “we don't yet have studies which demonstrate that reduced soft drink intake is a good way to control weight,” Dr. Dietz noted.

▸ Reduce portion size. This strategy “has a very robust impact on food intake,” he said. “The larger the portion an individual is exposed to, the more likely they are to overeat. We don't have good data that control of portion size is an effective way to reduce weight, but it is a logical potential strategy.”

“One of the problems is a lack of consistent messages,” he said. Young people need to hear a message from their physician, and then have that same message reinforced by what they hear in school, in the community, and from their parents.

Awareness of the problem of obesity among children and adolescents in the United States is starting to plateau, he said.

“I don't think we yet have strategies as effective as those which have been employed against tobacco [use]. Per capita cigarette consumption didn't decline because of a single intervention but because of multiple overlapping interventions,” Dr. Dietz said. “I think interventions with respect to obesity are going to be found in the clinical arena as well as in the schools and communities. We need more communication strategies and advocacy on your part.”

'Satiety does not appear to be regulated by calories. It appears to be regulated by the volume of food.' DR. DIETZ

SAN DIEGO — Perimenopausal women who took eszopiclone for 1 month experienced significant improvements in sleep problems brought on by hot flashes, results from a randomized trial have found.

However, the drug had no apparent effect on the number or severity of daytime and nighttime hot flashes, Rob Mariani, Ph.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“I think this is another example of how you can improve the quality of your life in great part by improving how well you can sleep at night, especially in perimenopausal women who complain of sleep difficulties,” said Dr. Mariani, senior medical liaison for Sepracor Inc., which markets eszopiclone under the brand name Lunesta. The nonbenzodiazepine drug was approved by the Food and Drug Administration in 2004 for the treatment of insomnia.

Dr. Mariani went on to note that most of the published studies in the area of menopause and sleep “indicate that there are really not any significant sleep architecture changes in patients at menopause or perimenopausal age. Yet at the same time, women who are perimenopausal and postmenopausal complain about a significant number of sleep problems, especially those who have vasomotor symptoms.”

In a study funded by Sepracor Inc., Dr. Mariani and his associates enrolled 410 perimenopausal women aged 40–60 years who met the Stages of Reproductive Aging Workshop criteria for early menopausal transition, late menopausal transition, and early postmenopause, and who reported sleep latency of 30 minutes or more and total sleep time of 6 hours or less per night at least three times a week for 1 month.

Investigators randomized 201 women to receive 3 mg eszopiclone and 209 to receive placebo nightly for 4 weeks. Study end points included sleep latency, wake time after sleep onset, total sleep time, awakenings due to hot flashes, daytime hot flashes, and physician global evaluations.

Scales used included the Greene Climacteric scale, the Montgomery Asberg Depression Rating scale, and the Menopause Quality of Life scale.

Compared with the women in the placebo group, those who took eszopiclone had significant changes in median sleep latency (reduction from baseline of 18.6 minutes vs. 8.1 minutes) and in median wake time after sleep onset (reduction of 30.6 minutes vs. 16 minutes). The increase in median total sleep time was greater among women who took eszopiclone (48.9 minutes per day vs. 29.7 minutes).

Although eszopiclone did not affect the frequency or duration of daytime hot flashes, it did yield significant benefits in the physician global evaluation of menopause symptoms, the Montgomery Asberg Depression Rating scale score, the Greene Climacteric scale score, and in the vasomotor and physical domains of the Menopause Quality of Life scale.

SAN DIEGO — Perimenopausal women who took eszopiclone for 1 month experienced significant improvements in sleep problems brought on by hot flashes, results from a randomized trial have found.

However, the drug had no apparent effect on the number or severity of daytime and nighttime hot flashes, Rob Mariani, Ph.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“I think this is another example of how you can improve the quality of your life in great part by improving how well you can sleep at night, especially in perimenopausal women who complain of sleep difficulties,” said Dr. Mariani, senior medical liaison for Sepracor Inc., which markets eszopiclone under the brand name Lunesta. The nonbenzodiazepine drug was approved by the Food and Drug Administration in 2004 for the treatment of insomnia.

Dr. Mariani went on to note that most of the published studies in the area of menopause and sleep “indicate that there are really not any significant sleep architecture changes in patients at menopause or perimenopausal age. Yet at the same time, women who are perimenopausal and postmenopausal complain about a significant number of sleep problems, especially those who have vasomotor symptoms.”

In a study funded by Sepracor Inc., Dr. Mariani and his associates enrolled 410 perimenopausal women aged 40–60 years who met the Stages of Reproductive Aging Workshop criteria for early menopausal transition, late menopausal transition, and early postmenopause, and who reported sleep latency of 30 minutes or more and total sleep time of 6 hours or less per night at least three times a week for 1 month.

Investigators randomized 201 women to receive 3 mg eszopiclone and 209 to receive placebo nightly for 4 weeks. Study end points included sleep latency, wake time after sleep onset, total sleep time, awakenings due to hot flashes, daytime hot flashes, and physician global evaluations.

Scales used included the Greene Climacteric scale, the Montgomery Asberg Depression Rating scale, and the Menopause Quality of Life scale.

Compared with the women in the placebo group, those who took eszopiclone had significant changes in median sleep latency (reduction from baseline of 18.6 minutes vs. 8.1 minutes) and in median wake time after sleep onset (reduction of 30.6 minutes vs. 16 minutes). The increase in median total sleep time was greater among women who took eszopiclone (48.9 minutes per day vs. 29.7 minutes).

Although eszopiclone did not affect the frequency or duration of daytime hot flashes, it did yield significant benefits in the physician global evaluation of menopause symptoms, the Montgomery Asberg Depression Rating scale score, the Greene Climacteric scale score, and in the vasomotor and physical domains of the Menopause Quality of Life scale.

SAN DIEGO — Perimenopausal women who took eszopiclone for 1 month experienced significant improvements in sleep problems brought on by hot flashes, results from a randomized trial have found.

However, the drug had no apparent effect on the number or severity of daytime and nighttime hot flashes, Rob Mariani, Ph.D., reported during a poster session at the American Psychiatric Association's Institute on Psychiatric Services.

“I think this is another example of how you can improve the quality of your life in great part by improving how well you can sleep at night, especially in perimenopausal women who complain of sleep difficulties,” said Dr. Mariani, senior medical liaison for Sepracor Inc., which markets eszopiclone under the brand name Lunesta. The nonbenzodiazepine drug was approved by the Food and Drug Administration in 2004 for the treatment of insomnia.

Dr. Mariani went on to note that most of the published studies in the area of menopause and sleep “indicate that there are really not any significant sleep architecture changes in patients at menopause or perimenopausal age. Yet at the same time, women who are perimenopausal and postmenopausal complain about a significant number of sleep problems, especially those who have vasomotor symptoms.”

In a study funded by Sepracor Inc., Dr. Mariani and his associates enrolled 410 perimenopausal women aged 40–60 years who met the Stages of Reproductive Aging Workshop criteria for early menopausal transition, late menopausal transition, and early postmenopause, and who reported sleep latency of 30 minutes or more and total sleep time of 6 hours or less per night at least three times a week for 1 month.

Investigators randomized 201 women to receive 3 mg eszopiclone and 209 to receive placebo nightly for 4 weeks. Study end points included sleep latency, wake time after sleep onset, total sleep time, awakenings due to hot flashes, daytime hot flashes, and physician global evaluations.

Scales used included the Greene Climacteric scale, the Montgomery Asberg Depression Rating scale, and the Menopause Quality of Life scale.

Compared with the women in the placebo group, those who took eszopiclone had significant changes in median sleep latency (reduction from baseline of 18.6 minutes vs. 8.1 minutes) and in median wake time after sleep onset (reduction of 30.6 minutes vs. 16 minutes). The increase in median total sleep time was greater among women who took eszopiclone (48.9 minutes per day vs. 29.7 minutes).

Although eszopiclone did not affect the frequency or duration of daytime hot flashes, it did yield significant benefits in the physician global evaluation of menopause symptoms, the Montgomery Asberg Depression Rating scale score, the Greene Climacteric scale score, and in the vasomotor and physical domains of the Menopause Quality of Life scale.

SAN DIEGO — Increased levels of C-reactive protein and other markers of perioperative inflammatory response are associated with neurocognitive decline following cardiac surgery, Dr. Basel Ramlawi said at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

Dr. Ramlawi and his associates prospectively evaluated 41 patients who underwent coronary artery bypass graft and/or valve procedures that used cardiopulmonary bypass. The patients' mean age was 67 years. All patients had neurocognitive testing preoperatively, postoperatively at day 4, and at 3 months. The validated tests took 45 minutes to administer and covered memory, executive function, naming, attention, fluency, and premorbid intelligence, said Dr. Ramlawi of the division of cardiothoracic surgery at Harvard Medical School, Boston. Neurocognitive decline was defined as performing one standard deviation from baseline on at least 25% of tasks.

Participants underwent serum testing preoperatively, postoperatively at 6 hours, and at 4 days. Levels of C-reactive protein (CRP) and of interleukin 1b, IL-6, and IL-10 were assessed, and an increase of serum tau protein after surgery was used as a marker of axonal central nervous system damage.

Of the 41 patients, 7 (17%) developed neurocognitive decline. Baseline characteristics and predictors of neurocognitive decline such as age, education level, and perioperative temperature did not differ significantly between patients with and without postoperative neurocognitive decline.

However, patients who experienced postoperative neurocognitive decline had significantly greater increases of CRP, IL-1b, and IL-10 than those who had no decline.

In addition, the level of tau protein was increased 78% in patients with neurocognitive decline, compared with 29% in their counterparts who did not show a decline.

“There exists a significant association [between] the magnitude and persistence of the perioperative inflammatory response and neurocognitive decline in this cohort,” Dr. Ramlawi said. “This association is likely mediated by axonal damage.”

According to the medical literature, the incidence of neurocognitive decline is 20%–60% in the first 2 weeks after cardiac surgery. “It can range from 5% to 40% for periods up to 5 years after surgery,” he said, adding that the etiology of this complication is not known.

“It is likely a multifactorial problem,” Dr. Ramlawi said. “Several theories have been assessed. The most obvious one is ischemia. Any microemboli might cause this.”

Other possible factors include anesthesia, perioperative hypothermia, and low level of education.

SAN DIEGO — Increased levels of C-reactive protein and other markers of perioperative inflammatory response are associated with neurocognitive decline following cardiac surgery, Dr. Basel Ramlawi said at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

Dr. Ramlawi and his associates prospectively evaluated 41 patients who underwent coronary artery bypass graft and/or valve procedures that used cardiopulmonary bypass. The patients' mean age was 67 years. All patients had neurocognitive testing preoperatively, postoperatively at day 4, and at 3 months. The validated tests took 45 minutes to administer and covered memory, executive function, naming, attention, fluency, and premorbid intelligence, said Dr. Ramlawi of the division of cardiothoracic surgery at Harvard Medical School, Boston. Neurocognitive decline was defined as performing one standard deviation from baseline on at least 25% of tasks.

Participants underwent serum testing preoperatively, postoperatively at 6 hours, and at 4 days. Levels of C-reactive protein (CRP) and of interleukin 1b, IL-6, and IL-10 were assessed, and an increase of serum tau protein after surgery was used as a marker of axonal central nervous system damage.

Of the 41 patients, 7 (17%) developed neurocognitive decline. Baseline characteristics and predictors of neurocognitive decline such as age, education level, and perioperative temperature did not differ significantly between patients with and without postoperative neurocognitive decline.

However, patients who experienced postoperative neurocognitive decline had significantly greater increases of CRP, IL-1b, and IL-10 than those who had no decline.

In addition, the level of tau protein was increased 78% in patients with neurocognitive decline, compared with 29% in their counterparts who did not show a decline.

“There exists a significant association [between] the magnitude and persistence of the perioperative inflammatory response and neurocognitive decline in this cohort,” Dr. Ramlawi said. “This association is likely mediated by axonal damage.”

According to the medical literature, the incidence of neurocognitive decline is 20%–60% in the first 2 weeks after cardiac surgery. “It can range from 5% to 40% for periods up to 5 years after surgery,” he said, adding that the etiology of this complication is not known.

“It is likely a multifactorial problem,” Dr. Ramlawi said. “Several theories have been assessed. The most obvious one is ischemia. Any microemboli might cause this.”

Other possible factors include anesthesia, perioperative hypothermia, and low level of education.

SAN DIEGO — Increased levels of C-reactive protein and other markers of perioperative inflammatory response are associated with neurocognitive decline following cardiac surgery, Dr. Basel Ramlawi said at a congress sponsored by the Association for Academic Surgery and the Society of University Surgeons.

Dr. Ramlawi and his associates prospectively evaluated 41 patients who underwent coronary artery bypass graft and/or valve procedures that used cardiopulmonary bypass. The patients' mean age was 67 years. All patients had neurocognitive testing preoperatively, postoperatively at day 4, and at 3 months. The validated tests took 45 minutes to administer and covered memory, executive function, naming, attention, fluency, and premorbid intelligence, said Dr. Ramlawi of the division of cardiothoracic surgery at Harvard Medical School, Boston. Neurocognitive decline was defined as performing one standard deviation from baseline on at least 25% of tasks.

Participants underwent serum testing preoperatively, postoperatively at 6 hours, and at 4 days. Levels of C-reactive protein (CRP) and of interleukin 1b, IL-6, and IL-10 were assessed, and an increase of serum tau protein after surgery was used as a marker of axonal central nervous system damage.

Of the 41 patients, 7 (17%) developed neurocognitive decline. Baseline characteristics and predictors of neurocognitive decline such as age, education level, and perioperative temperature did not differ significantly between patients with and without postoperative neurocognitive decline.

However, patients who experienced postoperative neurocognitive decline had significantly greater increases of CRP, IL-1b, and IL-10 than those who had no decline.

In addition, the level of tau protein was increased 78% in patients with neurocognitive decline, compared with 29% in their counterparts who did not show a decline.

“There exists a significant association [between] the magnitude and persistence of the perioperative inflammatory response and neurocognitive decline in this cohort,” Dr. Ramlawi said. “This association is likely mediated by axonal damage.”

According to the medical literature, the incidence of neurocognitive decline is 20%–60% in the first 2 weeks after cardiac surgery. “It can range from 5% to 40% for periods up to 5 years after surgery,” he said, adding that the etiology of this complication is not known.

“It is likely a multifactorial problem,” Dr. Ramlawi said. “Several theories have been assessed. The most obvious one is ischemia. Any microemboli might cause this.”

Other possible factors include anesthesia, perioperative hypothermia, and low level of education.

LA JOLLA, CALIF. — The link between environmental toxins and cancer and other diseases is so suggestive that health care professionals must do all they can to diminish the risks to public health, Dr. Mitchell L. Gaynor declared at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

Such an effort, he said, should be based on what Lancet editor Richard Horton termed “the precautionary principle.” This notion holds that “we must act on facts and on the most accurate interpretation of them, using the best scientific information,” Dr. Horton wrote (Lancet 1998;352:251–2). “That does not mean we must sit back until we have 100% evidence about everything. Where the … health of the people is at stake … we should be prepared to take action to diminish those risks, even when the scientific knowledge is not conclusive.”

“We should demand that this principle become part of public policy” in the treatment and prevention of environmental causes of disease, said Dr. Gaynor, of the Weill Medical College of Cornell University, New York.

“I gave a lecture at the United Nations in 2003 on water pollution as it related to all the countries on earth and the fact that very soon, clean drinking water is going to become a scarce commodity,” he said. “It's important that we become advocates for our own health.”

While evidence on the adverse health effects of chemical exposure continues to mount, steps toward more environmentally friendly policies are under way at many health care organizations around the globe. For example, Health Care Without Harm is an organization of almost 450 member groups in 52 countries that are working to reduce pollution in the health care industry (www.noharm.org

“Hospitals are huge releasers of a lot of pollutants, but this is starting to change,” Dr. Gaynor said at the meeting, which was cosponsored by the University of California, San Diego.

For example, more than 1,400 health care facilities in the United States have pledged to become mercury free, and 91% of chain pharmacies and the top 10 largest pharmacy chains have stopped selling mercury fever thermometers.

Consorta Inc., the large national health care group purchasing organization, supports the notion of greener and safer product innovation.

The decline of medical waste incinerators in the United States is an additional sign of a lean toward green. In 1998, there were 6,200 medical waste incinerators nationwide. By 2003, that number had dropped to 115. “Hopefully, there will be less need for even those,” said Dr. Gaynor, who is also the author of “Nurture Nature, Nurture Health: Your Health and the Environment” (New York: Nurture Nature Press, 2005).

An effort is also underway to phase out polyvinyl chloride IV tubing; when PVC products are produced or burned, they emit dioxins, which are associated with cancer and damage to the immune system.

'Hospitals are huge releasers of a lot of pollutants, but this is starting to change.' DR. GAYNOR

LA JOLLA, CALIF. — The link between environmental toxins and cancer and other diseases is so suggestive that health care professionals must do all they can to diminish the risks to public health, Dr. Mitchell L. Gaynor declared at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

Such an effort, he said, should be based on what Lancet editor Richard Horton termed “the precautionary principle.” This notion holds that “we must act on facts and on the most accurate interpretation of them, using the best scientific information,” Dr. Horton wrote (Lancet 1998;352:251–2). “That does not mean we must sit back until we have 100% evidence about everything. Where the … health of the people is at stake … we should be prepared to take action to diminish those risks, even when the scientific knowledge is not conclusive.”

“We should demand that this principle become part of public policy” in the treatment and prevention of environmental causes of disease, said Dr. Gaynor, of the Weill Medical College of Cornell University, New York.

“I gave a lecture at the United Nations in 2003 on water pollution as it related to all the countries on earth and the fact that very soon, clean drinking water is going to become a scarce commodity,” he said. “It's important that we become advocates for our own health.”

While evidence on the adverse health effects of chemical exposure continues to mount, steps toward more environmentally friendly policies are under way at many health care organizations around the globe. For example, Health Care Without Harm is an organization of almost 450 member groups in 52 countries that are working to reduce pollution in the health care industry (www.noharm.org

“Hospitals are huge releasers of a lot of pollutants, but this is starting to change,” Dr. Gaynor said at the meeting, which was cosponsored by the University of California, San Diego.

For example, more than 1,400 health care facilities in the United States have pledged to become mercury free, and 91% of chain pharmacies and the top 10 largest pharmacy chains have stopped selling mercury fever thermometers.

Consorta Inc., the large national health care group purchasing organization, supports the notion of greener and safer product innovation.

The decline of medical waste incinerators in the United States is an additional sign of a lean toward green. In 1998, there were 6,200 medical waste incinerators nationwide. By 2003, that number had dropped to 115. “Hopefully, there will be less need for even those,” said Dr. Gaynor, who is also the author of “Nurture Nature, Nurture Health: Your Health and the Environment” (New York: Nurture Nature Press, 2005).

An effort is also underway to phase out polyvinyl chloride IV tubing; when PVC products are produced or burned, they emit dioxins, which are associated with cancer and damage to the immune system.

'Hospitals are huge releasers of a lot of pollutants, but this is starting to change.' DR. GAYNOR

LA JOLLA, CALIF. — The link between environmental toxins and cancer and other diseases is so suggestive that health care professionals must do all they can to diminish the risks to public health, Dr. Mitchell L. Gaynor declared at a meeting on natural supplements in evidence-based practice sponsored by the Scripps Clinic.

Such an effort, he said, should be based on what Lancet editor Richard Horton termed “the precautionary principle.” This notion holds that “we must act on facts and on the most accurate interpretation of them, using the best scientific information,” Dr. Horton wrote (Lancet 1998;352:251–2). “That does not mean we must sit back until we have 100% evidence about everything. Where the … health of the people is at stake … we should be prepared to take action to diminish those risks, even when the scientific knowledge is not conclusive.”

“We should demand that this principle become part of public policy” in the treatment and prevention of environmental causes of disease, said Dr. Gaynor, of the Weill Medical College of Cornell University, New York.

“I gave a lecture at the United Nations in 2003 on water pollution as it related to all the countries on earth and the fact that very soon, clean drinking water is going to become a scarce commodity,” he said. “It's important that we become advocates for our own health.”

While evidence on the adverse health effects of chemical exposure continues to mount, steps toward more environmentally friendly policies are under way at many health care organizations around the globe. For example, Health Care Without Harm is an organization of almost 450 member groups in 52 countries that are working to reduce pollution in the health care industry (www.noharm.org

“Hospitals are huge releasers of a lot of pollutants, but this is starting to change,” Dr. Gaynor said at the meeting, which was cosponsored by the University of California, San Diego.

For example, more than 1,400 health care facilities in the United States have pledged to become mercury free, and 91% of chain pharmacies and the top 10 largest pharmacy chains have stopped selling mercury fever thermometers.

Consorta Inc., the large national health care group purchasing organization, supports the notion of greener and safer product innovation.

The decline of medical waste incinerators in the United States is an additional sign of a lean toward green. In 1998, there were 6,200 medical waste incinerators nationwide. By 2003, that number had dropped to 115. “Hopefully, there will be less need for even those,” said Dr. Gaynor, who is also the author of “Nurture Nature, Nurture Health: Your Health and the Environment” (New York: Nurture Nature Press, 2005).

An effort is also underway to phase out polyvinyl chloride IV tubing; when PVC products are produced or burned, they emit dioxins, which are associated with cancer and damage to the immune system.

'Hospitals are huge releasers of a lot of pollutants, but this is starting to change.' DR. GAYNOR