Antibiotic Brings Some Improvement in Fragile X Syndrome, Reports Journal of Developmental & Behavioral Pediatrics

Posted on April 9, 2013

Minocycline Show Benefits in Children with Inherited Cause of Intellectual Disability and Autism

Philadelphia, Pa. (April 8, 2012) – The antibiotic drug minocycline yields “modest” but meaningful improvements n functioning and mood for children with fragile X syndrome (FXS), reports a study in the April Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Three months of treatment with minocycline in children with FXS resulted in greater overall improvement than placebo treatment, according to the study by Dr Mary Jacena S. Leigh of University of California Davis Medical Center, Sacramento, and colleagues. They write, “This study is important because minocycline is a targeted treatment for FXS that is currently available by prescription.”

‘Global Improvement’ with Minocycline in Kids with FXS

Fragile X syndrome, which causes intellectual disability and behavioral and learning problems, affects about 1 in 4,000 males in the United States. It also occurs in females, but typically causes less severe impairment. Caused by mutations of a gene called FMR1, FXS is the most common cause of inherited intellectual disability and the most common genetic cause of autism and autism-spectrum disorders.

In the study, 66 children with FXS were randomly assigned to three months of treatment with minocycline or inactive placebo. After three months, they were switched to the other treatment. Parents and doctors were unaware of which treatment the child was receiving until the child completed the study.

Fifty-five patients completed the study. The children had small but significant improvements in certain areas during treatment with minocycline, compared to placebo. In particular, they scored better on the Clinical Global Impression Scale, where doctors rated their overall impression of the patients’ status. Average scores on the 7-point rating scale were 2.5 points for children taking minocycline versus 3 points for those taking placebo: a 0.5-point improvement with minocycline in comparison to placebo.

Children taking minocycline also had greater improvement in anxiety and mood-related behaviors, as rated by parents. Other outcomes were not significantly better with minocycline, including behavior problems and verbal functioning.

Side effects were generally similar between groups, with no serious adverse effects. Minocycline may cause some discoloration of the teeth—a known side effect of minocycline and related antibiotics, which was seen in both treatment arms.

Minocycline Is Only Available ‘Targeted Treatment’ for FXS

Minocycline is an older antibiotic, perhaps most commonly used for treatment of severe acne. Animal experiments and initial studies in humans have suggested that it might have beneficial effects in the treatment of FXS. Minocycline has also been studied as a potential “neuroprotective” treatment in other conditions, such as multiple sclerosis.

This preliminary clinical trial shows small but significant benefits of minocycline in children with FXS. Other treatments for FXS are being investigated, including a new class of drugs called mGluR5 inhibitors. However, minocycline is the only targeted FXS treatment that is currently available by prescription. Because of its long history of use, the side effects and safety characteristics of minocycline are well known.

More research will be needed to determine how minocycline exerts its beneficial effects in FXS, and to clarify the most effective dose and length of treatment. “Further studies including long term follow up on individuals treated with minocycline are warranted with a careful assessment of side effects and benefits,” Dr Leigh and colleagues conclude.

About the Journal of Developmental & Behavioral Pediatrics

Written for physicians, clinicians, psychologists and researchers, each bimonthly issue of the Journal of Developmental & Behavioral Pediatrics (www.jrnldbp.com) is devoted entirely to the developmental and psychosocial aspects of pediatric health care. Each issue brims with original articles, case reports, challenging cases and reviews—the latest work of many of today’s best known leaders in related fields—that help professionals across disciplines stay current with the latest information in the field. Relevant areas covered include learning disorders, developmental disabilities, and emotional, behavioral, and psychosomatic problems. Journal of Developmental & Behavioral Pediatrics is the official journal of the Society for Developmental and Behavioral Pediatrics.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

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Wolters Kluwer Health
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Non-invasive Mapping Helps to Localize Language Centers before Brain Surgery

Posted on April 8, 2013

‘Fast fMRI’ Protocol Could Aid in Planning Surgery for Epilepsy and Brain Tumors, Suggests Study in Neurosurgery

Philadelphia, Pa. (April 8, 2013) – A new functional magnetic resonance imaging (fMRI) technique may provide neurosurgeons with a non-invasive tool to help in mapping critical areas of the brain before surgery, reports a study in the April issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Evaluating brain fMRI responses to a “single, short auditory language task” can reliably localize critical language areas of the brain—in healthy people as well as patients requiring brain surgery for epilepsy or tumors, according to the new research by Melanie Genetti, PhD, and colleagues of Geneva University Hospitals, Switzerland.

Brief fMRI Task for Functional Brain Mapping

The researchers designed and evaluated a quick and simple fMRI task for use in functional brain mapping. Functional MRI can show brain activity in response to stimuli (in contrast to conventional brain MRI, which shows anatomy only). Before neurosurgery for severe epilepsy or brain tumors, functional brain mapping provides essential information on the location of critical brain areas governing speech and other functions.

The standard approach to brain mapping is direct electrocortical stimulation (ECS)—recording brain activity from electrodes placed on the brain surface. However, this requires several hours of testing and may not be applicable in all patients. Previous studies have compared fMRI techniques with ECS, but mainly for determining the side of language function (lateralization) rather than the precise location (localization).

The new fMRI task was developed and evaluated in 28 healthy volunteers and in 35 patients undergoing surgery for brain tumors or epilepsy. The test used a brief (eight minutes) auditory language stimulus in which the patients heard a series of sense and nonsense sentences.

Functional MRI scans were obtained to localize the brain areas activated by the language task—activated areas would “light up,” reflecting increased oxygenation. A subgroup of patients also underwent ECS, the results of which were compared to fMRI.

Non-invasive Test Accurately Localizes Critical Brain Areas

Based on responses to the language stimulus, fMRI showed activation of the anterior and posterior (front and rear) language areas of the brain in about 90 percent of subjects—neurosurgery patients as well as healthy volunteers. Functional MRI activation was weaker and the language centers more spread-out in the patient group. These differences may have reflected brain adaptations to slow-growing tumors or longstanding epilepsy.

Five of the epilepsy patients also underwent ECS using brain electrodes, the results of which agreed well with the fMRI findings. Two patients had temporary problems with language function after surgery. In both cases, the deficits were related to surgery or complications (bleeding) in the language area identified by fMRI.

Functional brain mapping is important for planning for complex neurosurgery procedures. It provides a guide for the neurosurgeon to navigate safely to the tumor or other diseased area, while avoiding damage to critical areas of the brain. An accurate, non-invasive approach to brain mapping would provide a valuable alternative to the time-consuming ECS procedure.

“The proposed fast fMRI language protocol reliably localized the most relevant language areas in individual subjects,” Dr. Genetti and colleagues conclude. In its current state, the new test probably isn’t suitable as the only approach to planning surgery—too many areas “light up” with fMRI, which may limit the surgeon’s ability to perform more extensive surgery with necessary confidence. The researchers add, “Rather than a substitute, our current fMRI protocol can be considered as a valuable complementary tool that can reliably guide ECS in the surgical planning of epileptogenic foci and of brain tumors.”

About Neurosurgery

Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world’s most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.

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‘Extracellular Vesicles’ May Open New Opportunities for Brain Cancer Diagnosis and Treatment

Posted on April 8, 2013

Researchers Exploring ‘Nano-Sized EVs’ for Identification, Monitoring and Treatment of Brain Tumors, Says Review in Neurosurgery

Philadelphia, Pa. (April 8, 2013) – The recent discovery of circulating “nano-sized extracellular vesicles” (EVs) carrying proteins and nucleic acids derived from brain tumors may lead to exciting new avenues for brain cancer diagnosis, monitoring, and treatment, according to a special article in the April issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The review article by Dr. David Gonda from the laboratory of the corresponding author Dr. Clark C. Chen, with contributions from the senior author, Dr. Bob S. Carter of University of California, San Diego, Dr. Fred Hochberg at Massachusetts General Hospital and Dr. Steve Kalkanis of the Henry Ford Hospital brain tumor programs discusses “the biological processes mediated by these EVs and their applications as biomarkers for brain tumor diagnosis, monitoring, and therapeutic development.” The researchers add, “Opportunity exists to use EVs as delivery vehicles or immune modulatory tools” for brain cancer treatment.

Nano-Sized EVs Play Role in Cancer Growth and Survival

The authors use the term EVs to refer to various types of “membrane-encapsulated cellular components” released from cells. Microscopic EVs—tiny even in relation to the cells that produce them—have been isolated from all bodily fluids, including the blood and cerebrospinal fluid of patients with brain tumors. Extracellular vesicles are like nano-sized “bubbles” of material sent out by cells, containing proteins and other cellular materials—including nucleic acids that carry genetic information.

So far, researchers have identified three general biological functions of EVs: remodeling and removal of cellular components; elimination of “toxic metabolites or unneeded membrane components” from cells; and intercellular communication, providing a means for transferring proteins or genetic information from one cell to another.

In patients with brain cancer, EVs may also provide a way for tumor cells to alter the microenvironment in which they grow. Different types of EVs may perform functions enabling cancers to grow and spread while evading the immune responses that would target tumor cells for destruction.

Could EVs Be Used for Cancer Detection and Treatment?

Scientific efforts to understand EVs and their functions—in normal physiology as well as in cancers and other disease states—are just getting started. But researchers envision new opportunities for the development of biomarkers for diagnosis and monitoring of brain cancers, as well as possible new treatment strategies based on EVs.

Approaches based on identifying specific proteins and genetic material carried by EVs could be useful in identifying brain cancers, and monitoring their status over time. For example, EVs might be used in identifying specific mutations of the IDH1 gene, recently linked to a type of brain cancer called glioblastoma multiforme. Corresponding author Dr. Chen noted in correspondence that “A large consortium effort among neurosurgeons and neuro-oncologists is emerging to assess the clinical utility of the basic science findings highlighted in our review. We anticipate that the next several years will yield important information as teams of scientists and clinicians work to study these questions.”

Further studies of the function of EVs may open at least three directions for brain cancer treatment. Treatments could be devised to inhibit the secretion and uptake of tumor-related EVs, which might interfere with their ability to grow or spread. New approaches to immunotherapy might be developed, using EVs to stimulate immune responses against tumor cells. It might also be possible to engineer EVs to serve as “delivery vehicles” to target drugs directly to cancer cells.

“Enhanced secretion of EVs by tumors offers an opportunity to detect tumor-specific genetic material as biomarkers for diagnostic or therapeutic monitoring,” the authors conclude. While extensive research is still needed to understand how EVs work and how they can be exploited for specific uses, they write, “Awareness of these developments should augment the armamentarium available to oncology-dedicated neurosurgeons.”

About Neurosurgery

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Gynecomastia Has Psychological Impact on Adolescent Boys, Reports Plastic and Reconstructive Surgery

Posted on April 3, 2013

Effects on Self-Esteem and Social Functioning Support ‘Early Intervention and Treatment’

Philadelphia, Pa. (April 2, 2013) – Persistent breast enlargement (gynecomastia) negatively affects self-esteem and other areas of mental and emotional health in adolescent males, reports the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Even mild gynecomastia can have adverse psychological effects in boys, according to the study by ASPS Member Surgeon Dr. Brian I. Labow and colleagues of Boston Children’s Hospital. They believe their findings have important implications for early intervention and treatment, including male breast reduction in appropriate cases.

Study Shows Psychological Impact of Gynecomastia in Boys

The researchers administered a series of psychological tests to 47 healthy boys, average age 16.5 years, being evaluated for gynecomastia. The results were compared to those of a group of boys without breast enlargement.

Sixty-two percent of the gynecomastia patients had mild to moderate breast enlargement. As in previous studies, many of the boys with gynecomastia were overweight or obese: 64 percent, compared to 41 percent of the comparison group.

Patients with gynecomastia had lower scores on a standard quality of life assessment, indicating problems in several areas. Even after adjustment for weight and body mass index (BMI), the patients had lower scores for general health, social functioning and mental health. They also had lower scores for physical health, but this was attributed to being overweight.

Breast enlargement was also associated with lower scores for self-esteem. This, along with impairment in emotional areas of quality of life, appeared directly related to gynecomastia, rather than being overweight.

Boys with gynecomastia also scored higher on a test of attitudes toward food and eating. However, there was no difference in the rate of clinical eating disorders between groups.

Psychosocial Effects Independent of Gynecomastia Severity

The negative psychological effects of gynecomastia were similar for boys at different levels of severity. “Merely having gynecomastia was sufficient to cause significant deficits in general health, social functioning, mental health, self-esteem, and eating behaviors and attitudes compared with controls,” Dr. Labow and coauthors write.

Gynecomastia is benign enlargement of male glandular tissue that is very common in adolescent boys. Although breast enlargement usually resolves over time, the problem persists in about eight percent of boys. Typically, boys with gynecomastia who are overweight or obese may simply be advised to lose weight.

However, losing weight won’t correct the problem in patients who have true glandular enlargement, or in those with a large amount of excess skin in the breast area. As shown by the new study, patients with gynecomastia may experience emotional and self-esteem issues regardless of body weight or the severity of breast enlargement.

“As a result, early intervention and treatment for gynecomastia may be necessary to improve the negative physical and emotional symptoms,” Dr. Labow and coauthors state. They note that male breast reduction, performed by a qualified plastic surgeon, is typically a simple and safe procedure.

It may seem self-evident that breast enlargement could have a psychological and emotional impact on teenage boys. However, adolescent gynecomastia has historically been regarded as a “cosmetic” procedure, not reimbursed by most insurance plans. The researchers note that only 35 percent of adolescent boys undergoing surgery for gynecomastia at their hospital were covered by insurance, compared to 85 percent of girls undergoing breast reduction.

“Our results indicate that careful and regular evaluation for gynecomastia may benefit adolescents regardless of BMI status or severity of gynecomastia,” Dr. Labow and colleagues conclude. They call for further studies to evaluate the effects of male breast reduction, including its impact on physical and psychological symptoms.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
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Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Psychiatry, Psychology and Addiction Medicine, Publications, Surgery - Plastic and Reconstructive | Leave a comment

‘Sharps’ Injuries Have Major Health and Cost Impact for Surgeons

Posted on April 3, 2013

Need for Increased Awareness, Reporting and Prevention, Says Review in Plastic and Reconstructive Surgery

Philadelphia, Pa. (April 2, 2013) – Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons—with high costs related to the risk of contracting serious infectious diseases, according to a special article in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

ASPS Member Surgeon Dr. Kevin C. Chung and colleagues at The University of Michigan Health System, Ann Arbor, review the risks, health impact and costs of “sharps” injuries for surgeons and other operating room personnel. They write, “Increased attention to the health, economic, personal and social implications of these injuries is essential for appropriate management and future prevention.”

High Rate of Sharps Injuries in OR—Surgeons at Highest Risk

Nearly 400,000 sharps injuries occur each year in the United States. About 25 percent of injured workers are surgeons—for whom the risk is highest in the operating room. “Despite healthcare policies designed to protect healthcare workers, injuries remain common,” Dr. Chung and colleagues write. Nearly all surgeons will sustain a sharps injury sometime during their career. Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The main health concern of sharps injuries is the risk of acquiring a communicable disease from a patient. While HIV is the most-feared result, the risk of infection with hepatitis B virus is actually much higher. Sharps injuries can also have a major psychological impact on the injured person and his or her family—particularly during the time needed to confirm that the injured worker is free of infection, which may take several weeks or months.

Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections. Recommendations include antiviral medications for healthcare workers exposed to HIV and hepatitis B or C virus—ideally starting within hours after the injury.

As a result of the need for testing and treatment, sharps injuries have a major economic impact. Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure from a patient with no known blood-borne illness, up to nearly $2,500 for injuries from a patient with known HIV.

Need for Increased Emphasis on Reporting and Prevention

Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons “never or rarely” report sharps injuries. They may feel they “don’t have time” to report, or may misunderstand the risks involved.

“Fortunately, the majority of sharps injuries are preventable,” Dr. Chung and colleagues write. Engineered safety devices can prevent many injuries—especially if surgeons and other workers are involved in choosing to use them. Other options include the use of “non-sharp” alternatives, creating safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection.

Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. Introduction of the Needlestick Safety and Prevention Act of 2000 led to an overall 38 percent reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room actually increased. “Although preventive strategies exist, their success ultimately relies on clinician compliance,” Dr. Chung and coauthors write.

The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude, “Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries.”

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

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Posted in All Medicine, Infectious Disease, Publications, Surgery - Plastic and Reconstructive | Leave a comment

New Technique Shows Promise in Restoring Near Vision without Glasses

Posted on April 1, 2013

Wearing OK Contact Lenses Every Night Can Restore Age-Related Loss of Near Vision

Philadelphia, Pa. (April 1, 2013) – By middle age, most people have age-related declines in near vision (presbyopia) requiring bifocals or reading glasses. An emerging technique called hyperopic orthokeratology (OK) may provide a new alternative for restoring near vision without the need for glasses, according to a study, “Refractive Changes from Hyperopic Orthokeratology Monovision in Presbyopes”, appearing in the April issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

For middle-aged patients with presbyopia, wearing OK contact lenses overnight can restore up-close vision in one eye, according to the study by Paul Gifford, PhD, FAAO, and Helen A Swarbrick, PhD, FAAO, of University of New South Wales, Sydney. “The authors have shown the feasibility of correcting one eye for near vision through OK, in which overnight contact lens wear shapes the cornea of one eye to allow in-focus near vision for reading,” comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science.

Overnight OK Lens Wear Restores Near Vision in One Eye

The study included 16 middle-aged patients (43 to 59 years) with age-related loss of near vision, or presbyopia. Presbyopia is caused by age-related loss of flexibility in the cornea—the transparent front part that lets light into the eye.

Orthokeratology is a clinical technique to correct vision using specially designed rigid contact lenses to manipulate the shape of the cornea. Dr Adams likens OK therapy to orthodontic treatment using braces to change the alignment of the teeth.

Drs Gifford and Swarbick evaluated a “monocular” technique, with patients wearing a custom-made OK lens in one eye overnight for one week. To preserve normal distance vision, the other eye was left untreated.

In all patients, the monocular OK technique was successful in restoring near vision in the treated eye. The improvement was apparent on the first day after overnight OK lens wear, and increased further during the treatment week. Eye examination confirmed that the OK lenses altered the shape of the cornea, as they were designed to do.

Nightly Lens Wear Needed to Retain Correction

Vision in the untreated eye was unaffected, and all patients retained normal distance vision with that eye; essentially this gives the patient the dequivalent of ‘monovision’ that is usually done with contact lenses or surgery. To retain the correction in near vision, patients had to continue wearing their OK lenses every night. Dr Adams likens this ongoing treatment to the “retainer” that orthodontic patients have to wear nightly. As expected, when patients stopped wearing their OK lens after the treatment week, presbyopia rapidly returned.

By about age 45 to 50, most people need bifocals or some other form of vision correction to restore vision for reading and other up-close tasks. Alternatives for presbyopia have been introduced, including fitting a contact lens for distance vision in one eye and a lens for near vision in the other eye. This is the so called monovision, now the authors show it can be achieved without the need to wear a contact lens during the day. “However, the chief problem with monovision for many people is that their stereoscopic 3D vision is degraded and many find that hard to tolerate,” according to Dr Adams.

Although overnight OK is not a new technique, it has been mainly used to reduce nearsightedness (myopia) in younger patients. The new study shows that OK is similarly effective in changing corneal shape, and achieving desired correction in near vision, in older patients with presbyopia.

The new study suggests that overnight OK lenses are a feasible alternative for correction of presbyopia, “sufficient to provide functional near vision correction white retaining good distance visual acuity,” Drs Gifford and Swarbick write. The technique is safe, with the cornea returning to its previous shape about a week after the patient stops wearing the lenses.

“This study demonstrates that OK is quite viable as a nonsurgical option for monovision that does not require wearing contact lenses during the day, although it does require ‘retainer’ orthokeratology contact lenses to be worn overnight,” Dr Adams adds. “This possibility will certainly appeal to many people, especially since the changes in the corneal curvature of the treated eye are fully reversible.”

To read the article, “Refractive Changes from Hyperopic Orthokeratology Monovision in Presbyopes”, please visit http://journals.lww.com/optvissci/Fulltext/2013/04000/Refractive_Changes_From_Hyperopic_Orthokeratology.3.aspx

About Optometry and Vision Science

Optometry and Vision Science, official journal of the American Academy of Optometry, is the most authoritative source for current developments in optometry, physiological optics, and vision science. This frequently cited monthly scientific journal has served primary eye care practitioners for more than 75 years, promoting vital interdisciplinary exchange among optometrists and vision scientists worldwide.

About the American Academy of Optometry

Founded in 1922, the American Academy of Optometry is committed to promoting the art and science of vision care through lifelong learning. All members of the Academy are dedicated to the highest standards of optometric practice through clinical care, education or research.

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
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Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
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Posted in Optometry, Publications | Leave a comment

Leading Experts Disagree on Evidence behind Prostate Cancer Screening Recommendations

Posted on March 25, 2013

Is Randomized Trial Data Enough to Recommend Against Routine PSA Screening? ‘Point/Counterpoint’ Debate in Medical Care

Philadelphia, Pa. (March 25, 2013) – Do the results of recent randomized trials justify the recent U.S. recommendation against yearly measurement of prostate-specific antigen (PSA) as a screening test for prostate cancer? That’s the topic of debate in a special “point/counterpoint” section in the April issue of Medical Care. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The recommendation against routine PSA measurement relies too heavily on randomized trial data, according to an article by Ruth Etzioni, PhD, of Fred Hutchinson Cancer Research Center, Seattle, and colleagues. They argue that modeling studies provide a truer picture of the long-term benefits of PSA screening. But Dr Joy Melnikow of University of California, Davis, and colleagues disagree, asserting that randomized trials provide a sufficient level of certainty to recommend against PSA screening.

Point: Short-Term Trials Don’t Reflect Long-Term Risk

Last year, the U.S. Preventive Services Task Force recommended against routine PSA measurement to screen for prostate cancer. The recommendation was mainly based on two recent studies—one conducted in Europe and one in the United States—in which men were randomly assigned to annual PSA screening or no screening. Both studies concluded that annual screening did not reduce the risk of death from prostate cancer.

But randomized trials have important limitations as a basis for screening policies, according to Dr Etzioni and colleagues. They note that screening trials generally provide short-term results, in contrast to the long-term results generated by population-wide screening programs. They argue that taking the randomized trial data at face value “misrepresents the likely long-term population impact of PSA screening (relative to no screening) in the United States.”

Dr Etzioni and coauthors discuss the results of modeling studies that give a different picture of the benefits of PSA screening. Based on those models, screening may explain 45 percent of recent declines in U.S. deaths from prostate cancer, while changes in treatment account for 33 percent. When the randomized trial data are extrapolated to the U.S. population over the long term, the absolute reduction in deaths attributed to screening appears at least five times greater than in the original trial reports.

Modeling studies also suggest a lower rate of overdiagnosis—screening detection of slow-growing prostate cancers that otherwise would have caused no harm—than reported in the trials. Dr Etzioni and colleagues conclude, “With a disease whose hallmark is a lengthy natural history, the harms of developing cancer screening policies based primarily on limited-duration screening trials may well outweigh the benefits.”

Counterpoint: Trials Are Best Evidence on Screening Effects

But in their “Counterpoint” essay, by Dr Melnikow and colleagues notes that the U.S. and European trials provided 11 to 13 years’ follow-up in more than 250,000 individuals. They also point out that the U.S. trial was highly representative of the population and showed no reduction in death resulting from annual PSA testing. (Dr Melnikow and colleagues were members of the U.S. Preventive Services Task Force when the recommendation was made.)

They add that, because of “competing causes of death,” it becomes even less likely that a large reduction in deaths from prostate cancer will appear over long-term follow-up. The chances of overdiagnosis and potential harms from screening are also likely to increase with continued aging. Dr Melnikow and coauthors conclude, “Projections from models are subject to mistaken assumptions and investigator biases, and should not be accorded the same weight as evidence from randomized controlled trials.”

In an editorial response, Dr Etzioni’s group points out that modeling plays an essential role in addressing questions about the harms and benefits of screening. “While we acknowledge the centrality of screening trials in the policy process,” they write, “we maintain that modeling constitutes a powerful tool for screening trial interpretation and screening policy development.”

The debate is “no mere academic exercise,” according to an editorial by Ronnie D. Horner, PhD, of University of Cincinnati Medical Center. With the increased emphasis on disease prevention under health care reform, it is essential to offer those services most likely to represent value—including cancer screenings. While there’s no easy answer, Dr Horner writes, “I am hopeful that this Point-Counterpoint exchange will initiate a discussion among healthcare scientists that will yield greater guidance for determining whether a health care service is, indeed, value health care.”

About Medical Care

Rated as one of the top ten journals in health care administration, Medical Care is devoted to all aspects of the administration and delivery of health care. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of health care. Medical Care provides timely reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services. In addition, numerous special supplementary issues that focus on specialized topics are produced with each volume. Medical Care is the official journal of the Medical Care Section of the American Public Health Association

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Family Medicine, General Practice, and Primary Care, Oncology, Publications | Leave a comment

Advances in Inflammatory Bowel Disease—What’s New, What’s Next

Posted on March 22, 2013

Crohn’s & Colitis Foundation of America’s ‘Challenges in IBD Research’ Published in Inflammatory Bowel Diseases

Philadelphia, Pa. (March 22, 2013) – Every five years, the Crohn’s & Colitis Foundation of America (CCFA) gathers top researchers in inflammatory bowel disease (IBD) to set the research agenda for the next five years. The findings and recommendations of these expert workgroups are presented in a series of detailed “Challenges in IBD Research” reports, now available in Inflammatory Bowel Diseases, official journal of the CCFA. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Each workgroup is assigned to specific topic areas including genetics, epidemiology and environmental factors, the “microbiome” (intestinal bacteria), epithelial cell biology, innate and adaptive immunity, clinical classification and prognostic models, and optimizing medical therapy. A special “Challenges in IBD Research” progress report appears in the March issue of Inflammatory Bowel Diseases. The complete workgroup reports are available for direct download at http://links.lww.com/IBD/A77.

Experts Outline New Agenda for IBD Research

Based on a thorough review in each area, the workgroups have defined key research priorities for the next few years, including:

Defining clinically relevant subgroups of IBD patients—using different types of information to predict aggressiveness of disease, complications, and response to treatment.
Understanding the environmental factors affecting the risk and course of IBD—including environmental “triggers” and a specific focus on the role of diet.
Clarifying the complex interrelationships among genes, bacteria, and epithelial and immune responses—focusing on cellular pathways and critical cell types that may lead to new “therapeutic targets.”
Determining the optimal treatment approaches and strategies through comparative effectiveness studies.

The workgroup reports also identify the resources needed to carry out this ambitious research agenda, including a “centralized and distributable infrastructure” for integrated studies of IBD in humans and long-term follow-up studies of children and adults with IBD.

“Through development of the ambitious research goals outlined in this document, the Crohn’s & Colitis Foundation of America has again led the effort to further the understanding of IBD,” said Dr. Lee Denson of Cincinnati Children’s Hospital Medical Center. “CCFA is keen to advance this research agenda in 2013 and beyond.”

Building on Recent Scientific and Clinical Advances

The CCFA research agenda builds on recent advances in scientific and clinical research. They include major strides in IBD genetics—more than 160 genes affecting susceptibility to Crohn’s disease and ulcerative colitis have now been identified. Using sophisticated techniques, researchers have gained new insights into the complex interactions between intestinal bacteria and immune responses, including the role of specific types of immune cells.

Clinical studies have improved the ability to predict the response to IBD treatment in children and to track the short- and long-term adverse effects of IBD treatments. Progress has also been made in understanding the risks and benefits of medical and surgical treatments for key patient subgroups, including pregnant women and newborns. These studies point the way toward future efforts to optimize treatment for individual patients with IBD.

About Inflammatory Bowel Diseases

Inflammatory Bowel Diseases brings the most current information in clinical and basic sciences to physicians caring for patients with inflammatory bowel diseases, and investigators performing research in IBD and related fields. Each issue contains cutting-edge original basic science and clinical articles on diagnosis, treatment, and management of IBD from clinicians and researchers around the world. Coverage includes articles highlighting the unique and important issues in pediatric IBD, as well as articles pertaining to adult patients.

About the CCFA

The Crohn’s & Colitis Foundation of America is a non-profit, volunteer-driven organization dedicated to finding the cures for Crohn’s Disease and ulcerative colitis. It was founded in 1967 by Irwin M. and Suzanne Rosenthal, William D. and Shelby Modell, and Henry D. Janowitz, M.D. Since our founding over four decades ago, CCFA has remained at the forefront of research in Crohn’s disease and ulcerative colitis. Today, we fund cutting-edge studies at major medical institutions, nurture investigators at the early stages of their careers, and finance underdeveloped areas of research.

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Gastroenterology and Hepatology, Internal Medicine, Publications | Leave a comment

AAP and AJPM&R Announce Excellence in Research Writing Award Winners

Posted on March 19, 2013

Dr Alberto Esquenazi Wins ‘Best Paper’ for Study on ReWalk Exoskeleton Aiding Spinal Cord Injured
Patients Walk Independently

Philadelphia, PA (March 13, 2013) – The Association of Academic Physiatrists (AAP) and the editors of American Journal of Physical Medicine & Rehabilitation (AJPM&R), the official journal of the AAP, announced that Alberto Esquenazi, MD, has been named winner of the 2012 AAP Excellence in Research Writing Award for Best Paper. The publisher of AJPM&R, Lippincott Williams & Wilkins, part of Wolters Kluwer Health, sponsored the award to help raise awareness of important research in the field of physical medical rehabilitation.

Dr Esquenazi was lead author of the 2012 Best Paper, which reported on the successful use of the ReWalk powered exoskeleton to restore walking ability to patients with thoracic-level spinal cord injury. The award was presented at a ceremony during the 2013 AAP Annual Meeting, held last week in New Orleans.

Award Honors Some of the Year’s Best Papers from AJPM&R

The award-winning paper, “The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury,” appeared in the November, 2012, issue of AJPM&R. Dr Esquenazi’s coauthors were Mukul Talaty, PhD, Andrew Packel, PT, NCS, and Michael Saulino, MD, PhD.

Video Shows Patient Using ReWalk Exoskeleton

Dr Esquenazi and coauthors reported their initial experience with the ReWalk powered exoskeleton in twelve patients with SCI, including the intensive training regimen required. After fitting and training with ReWalk, all patients learned to walk independently. A video showing a patient using the ReWalk exoskeleton can be viewed on the AJPM&R website.

In addition, Siera Goodnight, MPH, was named winner of the 2012 Ernest W. Johnson Excellence in Research Writing Award for the best paper on which the first author was in-training when the paper was written. Ms Goodnight’s paper, “Construct Validity of Language Independent Functional Evaluation as Used by Spanish-Speaking Clinicians to Evaluate Persons with Developmental Delays,” was published in the February, 2012, issue of AJPM&R. Her coauthors were Tony Boggess, DO, Carlos Quintero, MD, Diana Mejia, Juan Felipe Amezquita, Karen S.J. Yamakawa, MS, and Andrew J. Haig, MD.

The AAP Excellence in Research Writing Award recognizes the lead author of the best paper published in AJPM&R each year. Winners are selected by a committee from the Editorial Board, appointed by the Editor.

The committee also presented Honorable Mention awards for two additional papers published in AJPM&R: “Development of an Objective Test of Upper-Limb Function in Tetraplegia: The Capabilities of Upper Extremity Test” by Ralph J. Marino, MD, MS, Mary Patrick, RN, MSN, Whitney Albright, MS, OTR/L, Benjamin E. Leiby, PhD, MJ Mulcahey, OTR/L, PhD, Mary Schmidt-Read, PT, DPT, and Stephen B. Kern, OTR/L, PhD (June, 2012); and “Skeletal Muscle Plasticity after Hemorrhagic Stroke in Rats: Influence of Spontaneous Physical Activity” (November, 2012) by LeAnn Snow, MD, PhD, Walter C. Low, PhD, and LaDora V. Thompson, PhD.

About AJPM&R

American Journal of Physical Medicine & Rehabilitation focuses on the practice, research and educational aspects of physical medicine and rehabilitation. Monthly issues keep physiatrists up-to-date on the optimal functional restoration of patients with disabilities, physical treatment of neuromuscular impairments, the development of new rehabilitative technologies, and the use of electrodiagnostic studies. The Journal publishes cutting-edge basic and clinical research, clinical case reports and in-depth topical reviews of interest to rehabilitation professionals.

About the Association of Academic Physiatrists

The AAP was founded in 1967 to serve as the national organization of physiatrists who are affiliated with medical schools. The AAP is a member organization of the Association of American Medical Colleges (AAMC). The objectives of the Association are to promote the advancement of teaching and research in Physical Medicine and Rehabilitation within an academic environment. The organization acts as a sounding board and forum for the exchange of ideas and information relative to all phases of the art and science of Physical Medicine and Rehabilitation.

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Media, Physical Medicine & Rehabilitation, Publications | Leave a comment

Study Shows Rising Rate of Propofol Abuse by Health Care Professionals

Posted on March 19, 2013

Abuse of Common Anesthetic Has “Rapid Downhill Course,” Reports Journal of Addiction Medicine

Philadelphia, Pa. (March 18, 2013) – Abuse of the anesthesia drug propofol is a “rapidly progressive form of substance dependence” that is being more commonly seen among health care professionals, reports a study in the April Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“Propofol addiction is a virulent and debilitating form of substance dependence” with a “rapid downhill course,” write Drs Paul Earley and Torin Finver of Georgia Health Professionals Program, Inc, Atlanta. Their study identifies some emerging characteristics and consequences of propofol abuse among health care professionals.

Propofol Abuse: Rates and Risk Factors

Data from an addiction center specializing in substance abuse problems among health care professionals identified 22 patients treated for propofol abuse from 1990 to 2010. Propofol is a drug widely used to induce anesthesia for surgery and sedation for other procedures. It is commonly used because it has a rapid onset and quick recovery time, with fewer side effects than other anesthetics.

The number of health care professionals treated for propofol abuse increased steadily during the period studied, although increased recognition by addiction center staff may have played a role. The patients were thirteen physicians, eight nurses, and one dentist. Most of the physicians and all of the nurses were anesthesia providers, who had ready access to propofol.

Patients using propofol were more likely to be women, compared to health care professionals abusing alcohol or other drugs. Most propofol abusers had depression, along with a history of childhood sexual or physical abuse. In addition, most of the propofol-abusing health care professionals reported a family history of substance abuse, and a higher than expected number had family members with schizophrenia.

The patients generally started using propofol to get to sleep. However, they quickly developed characteristics of addiction, with propofol becoming a preferred drug of abuse. Most patients came for addiction treatment within a few months after starting to use propofol. Five patients came to treatment after a single propofol binge.

Side Effects of Propofol Abuse ‘Begin Almost Immediately’

“When humans abuse propofol, unintended side effects begin almost immediately,” Drs Earley and Finver write. About half of propofol abusers entered addiction treatment after dramatic events such as car crashes or other injuries. Some sustained facial injuries when they passed out immediately after injecting propofol.

Five patients were admitted into treatment when they were discovered unconscious. These characteristics reflect the “narrow window between desired effect and unconsciousness” and the rapid loss of control over propofol use, according to the authors.

“Propofol dependence is a rapidly progressive form of substance dependence seen in 1.6 percent of all health care addiction cases reporting to treatment,” Drs Earley and Finver conclude. Within the limitations of the data, the study suggests that propofol abuse by health care professionals is increasing—particularly among physician and nurse anesthesia providers with ready access to anesthetics.

Some characteristics of the patients studied—including their history of depression and childhood trauma and patterns of physical injury—have important implications for identification and treatment of propofol abuse by health care professionals. Drs Earley and Finver add, “Outcome studies…are needed to help solve the difficult decisions of when and if a propofol-abusing health care professional should return to their high-risk work environment.”

About Journal of Addiction Medicine

The mission of Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical specialty. Published bi-monthly, the Journal is designed for all physicians and other mental health professionals who need to keep up-to-date with the treatment of addiction disorders. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics,

About the American Society of Addiction Medicine

The American Society for Addiction Medicine is a professional society representing over 3,000 physicians dedicated to increasing access and improving quality of addiction treatment, educating physicians and the public, supporting research and prevention, and promoting the appropriate role of physicians in the care of patients with addictions.

About Lippincott Williams & Wilkins

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Posted in All Medicine, Psychiatry, Psychology and Addiction Medicine, Publications | Leave a comment

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