A no-brainer
Heart bypass surgery, in rare cases, can lead to brain injury, but a recent study from DMS and Maine Medical Center suggests a way to reduce the risk. In a small study, the researchers found that papaverine—a drug commonly used during bypass surgery to improve blood flow—was more effective when applied topically to a vessel than when injected into a vessel. Signals indicating reduced blood flow to the brain were observed in seven of 12 patients who were injected with papaverine versus none of 28 who received the drug topically.

Real-world result
A common treatment for post-traumatic stress disorder (PTSD) doesn't produce the same result in the real world as it does in randomized controlled trials. DMS researcher Claudia Zayfert, Ph.D., and colleagues observed that only 28% of patients undergoing cognitive behavioral therapy for PTSD finished their treatment, whereas 73% of patients in randomized controlled trials did. The completion rate, they observed in the Journal of Traumatic Stress, "although disturbingly low, was better than expected." And since research definitions of completion differ from clinical definitions, they say, the gap between the studies may not be quite so large.

Performance indicators
Senior citizens usually don't consult hospital performance data when deciding where to have surgery. So found a survey of Medicare patients by researchers at the DMS-affiliated VA Medical Center. Most of those surveyed "relied primarily on the opinions of their referring physician or family and friends in choosing where to have surgery," wrote Lisa Schwartz, M.D., and colleagues in the British Medical Journal. Many said they'd switch hospitals based on mortality data, but since they rely on their physician's opinion, the researchers argued that "performance data should be directed at referring physicians," not patients.

Calculating cancer's effect
It's no surprise to learn that breast cancer patients experience mental and emotional distress. A study by DHMC's Comprehensive Breast Program revealed just how common psychological disturbances are among women with early-stage breast cancer. "We found that 46% of the 185 women that we screened . . . meet or exceed our established thresholds for mental health intervention," said Caroline Moore, M.P.H., at a recent breast cancer symposium in Texas. About 42% of the women had high stress levels, almost 11% were depressed, and about 9% showed signs of clinical anxiety.

Surgical advice
Between one-third and two-thirds of patients undergoing gastric bypass surgery—a treatment for severe obesity—develop gallstones. A study by DMS surgeon Brent White, M.D., found that the most cost-effective ways to prevent them are removing the gallbladder at the time of the bypass and treating the patient with the drug ursodiol for six months after surgery. "Surgeons . . . should consider either using ursodiol or performing a concurrent cholecystectomy," White advised at the annual meeting of the American College of Surgeons.

Fungal finding
A class of deadly fungal infections called Zygomycoses was the subject of a paper by Jack Brown, Pharm.D. "Zygomycosis appears to have become more common since the mid-1990s," he wrote in the American Journal of Health-System Pharmacy, "and has been identified in up to 6.8% of patients at autopsy." Brown summarized the taxonomy, epidemiology, pathogenesis, diagnosis, and treatment of these dangerous fungi. Patients at the highest risk of infection, he reported, are diabetics, intravenous drug abusers, premature infants, recipients of bone marrow transplants, and those who get certain therapies to remove excess iron from the body.

In a study of 1,500 patients, DMS gastroenterologist Douglas Robertson, M.D., found that those with diets high in processed meats had a higher risk of developing precancerous colon polyps.

A randomized, controlled trial led by DMS's Allen Dietrich, M.D., showed that a series of phone calls can significantly improve cancer screening rates among low-income women.

Two Dartmouth researchers mapped anatomical changes in the brains of college freshmen and determined that the brain's structure continues to change significantly after age 18.