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Artificial intelligence?
To ensure that they've interpreted mammograms correctly, most radiologists turn not to another physician but to a computer. In a survey, DMS researcher Tracy Onega, Ph.D., found that far more radiologists rely on computer-aided detection (CAD) to confirm mammography readings than ask for a second opinion from another radiologist—even though more physicians believe a second reading by a human would improve cancer detection rates. "Radiologists' perception of CAD and double reading is important for clinical practice at the level of individual radiologists and also from a larger perspective related to the diffusion of technology," Onega wrote in Academic Radiology.

No stomach for rising rate
A team of DMS researchers examined trends in the incidence of esoph ageal adenocarcinoma, cancer in the muscular tube that connects the mouth to the stomach. From 1973 to 1996, the rate rose sharply, from 3.6 cases per million Americans to 21.9 per million, an annual increase of about 8%. But from 1996 to 2006, the average annual increase was only 1.3%. "Our results suggest that the previously observed steady increase in esophageal adenocarcinoma incidence has slowed, which represents a significant change in trend," they concluded.

DH's Paul Palumbo, M.D., described in the New England Journal of Medicine a new therapy for pediatric AIDS, tested in six African nations, that is better and cheaper than current therapy.

Back in the OR
For patients with symptomatic lumbar spinal stenosis—a narrowing of the spinal column in the lower back—surgery is likely a better option than nonsurgical treatment, according to a long-term study. A team led by DH's James Weinstein, D.O., followed about 650 patients for four years, comparing pain and function in those who had surgery to outcomes in patients treated with interventions such as physical therapy and medications. "Those treated surgically showed significantly greater improvement . . . compared to patients treated nonoperatively," the researchers reported in the journal Spine.

White coats, red ink
"Physicians cannot make the decision to follow a [primary-care] career path lightly," concluded DH's Martin Palmeri, M.D., and colleagues in a recent article. They found that, given the heavy debt most medical students incur and the long training for medicine, primary-care physicians may spend the first three to five years of their careers earning less than their expenses, forcing them to make difficult choices that colleagues in more lucrative subspecialties may avoid. Writing in Academic Medicine, the authors argue that this discrepancy should be addressed through loan repayments or other programs to encourage interest in primary care.

Diane Gilbert-Diamond, D.Sc., a research associate at Dartmouth, was the first author on a paper which reported that children who are deficient in Vitamin D are likely to gain weight rapidly.

Now 'ear this
Doctors often use antibiotics to treat a draining ear, because the draining pus is often due to a bacterial infection. To study the spread of antibiotic-resistant bacteria, DH otolaryngologist James Saunders, M.D., examined cultures from 170 patients. He found that bacteria in 40% of the cultures showed resistance to at least some antibiotics, and in 5% to all oral antibiotics. "Antibiotic therapy has greatly facilitated the management of ear infections; however, frequent antibiotic use and misuse have led to the development of resistant strains, complicating the management of the draining ear," he wrote in an otolaryngology journal.

Environment and exercise
There are many obstacles—environmental as well as mental—that inhibit mothers in rural areas from getting exercise, found DMS researchers. "Barriers to physical activity in rural areas include having fewer places where one can be physically active and exercise locations being located too far away," they wrote in the Journal of Women's Health. "With all the benefits that physical activity can offer—decreased stress, increased health, and positive role modeling for the family—it seems worthwhile to provide support enabling mothers to make physical activity a priority."

DMS's Kathryn Zug, M.D., was invited to share with 800 European dermatologists findings on eczema-like symptoms from a decade of research by a professional group of which she is an officer.


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