Focus on Recent Research
This section includes brief accounts of selected Dartmouth research projects on biomedical and health-policy issues.
A hot topic
Overheating may significantly increase the chance that a newborn will succumb to sudden infant death syndrome (SIDS). That early result from the lab of DMS's Dr. Donald Bartlett was presented at a meeting of the American Physiological Society. He found that increasing the temperature of baby pigs only a few degrees produced prolonged periods of unstable breathing. He plans to further test the finding. More money isn't better A pair of Dartmouth economists found that patients in states that spend the most on Medicare get less effective care. Katherine Baicker and Amitabh Chandra looked at how often patients received 24 treatments known to be effective-such as regular eye exams for diabetics- and discovered that rates are lower in the states that spend the most; in high-spending states, funds are put into intensive, expensive care, not proven, basic care. "Improving care has everything to do with how the money is spent," says Chandra. The study was published in Health Affairs.
A pediatric "tool kit"
"Introducing change into a busy pediatric practice is like trying to repair a bicycle while riding it," asserts Dr. Carl Cooley, an adjunct member of the DMS faculty. So he and a colleague, research associate Jeanne McAllister, developed a "tool kit" to help pediatricians refocus their practices to better serve children with complex, multiple health-care needs. Their concept-based on close-to-home care-was refined in four private practices throughout Vermont and New Hampshire and was described in a recent issue of the journal Pediatrics.
Technology doesn't always distance patients from their health-care providers. Adjunct faculty member Cornelia Ruland asked 52 outpatients at Dartmouth's Norris Cotton Cancer Center to use an electronic touch pad to record their symptoms before their appointments. In a control group, nothing was done with the information; in the experimental group, the results were printed out and given to the clinician before the consultation. After their visits, patients were asked which concerns had been addressed. In the control group, only 20% of symptoms were addressed, but in the experimental group 55% were. The findings were published in the Journal of the American Informatics Association, and Ruland just received three years of funding to further test the concept.
What a CAD!
Coronary artery disease (CAD) is the leading cause of death in the industrialized world. But the most widely used noninvasive means of detecting it-an exercise test-has a high rate of both false positives and false negatives. A promising new diagnostic method based on changes in a blood marker is being tested by Dr. Robert Foote, a cardiologist at Dartmouth. He compared levels of a neurohormone called B-natriuretic peptide (BNP) before and after exercise. "Over 90% of the patients with inadequate blood flow showed an abnormal increase in BNP," says Foote. "Only 37.5% of the same patients' electrocardiograms showed abnormal patterns." The work was published in the journal Circulation.
A fast brake
Pancreatic cancer is an aggressive and cagy foe: it spreads rapidly and resists traditional chemotherapy. Dr. Murray Korc, chair of medicine at DMS, likens the disease to a car with a stuck accelerator. "Naturally, you apply the brakes," he says. Yet not only do the brakes not work, but the cancer has converted them into an accelerator. "In essence," Korc explains, "pumping the brakes gives you two accelerators." There is promise, however, in a recent report from Korc's lab of a new method of treating the disease. It focuses on the over-expression of a molecule called VEGF, which hampers chemotherapeutic efforts against pancreatic cancer. The lab's findings were reported in the journal Clinical Cancer Research.
One of the leading causes of stroke is blockage of the carotid artery-the vessel in the neck that supplies blood to the brain. Surgery to remove blockages in high-risk patients results in serious complications or death in as many as 14.5% of cases. But a DHMC study involving 100 such patients who received a far less invasive procedure- clearing the artery of plaque by in- flating a "balloon" in it, and then inserting a tiny metal tube called a stent-"far surpassed our expectations," says Dr. Richard Powell, chief of interventional vascular surgery. "We had no deaths and no major strokes in these patients, despite their highrisk status." The results were published in the Journal of Vascular Surgery.
DMS cancer researchers have discovered a new vitamin in a molecular pathway central to such vital processes as gene regulation, metabolism, and aging. And, they found, milk contains this nutrient. Nicotinamide riboside had been thought to be a vitamin form of a common small molecule that appeared only in certain bacteria. But the researchers saw it had properties of a vitamin in yeast and then identified it in the whey of milk. Conducted in the lab of Charles Brenner, the work was published in a recent issue of the journal Cell.
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