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Vital Signs
Media Mentions: DMS and DHMC in the News
Among the people and programs coming in for
prominent media coverage in recent months
was DHMC's director of palliative medicine. A
New York Times feature on hospice care noted that
Dartmouth's Dr. Ira Byock, "a nationally recognized
expert in palliative care, . . . says hospice should
be viewed not as giving up all hope but about getting
the care one needs. . . . Byock
rejects the notion that the
only point of hospice is to help
people die." Byock was also the
subject of a profile in the Boston
Globe's Sunday magazine section,
which said that he believes
"the core of palliative care, ultimately,
is not law or policy but the ongoing interaction
with patients." See here in this issue
for more about Byock's impact at DHMC.
A feature in Smithsonian on facial reconstruction techniques in World War I quoted a Dartmouth expert who compared injuries from WWI to those seen in Iraq. "'We're used to thinking about losing an arm or an eye or an ear,' says Dr. Joseph Rosen, a plastic surgeon at Dartmouth who works with soldiers injured in Iraq. 'When you lose all these things simultaneously—[and] the blast injuries take your arms with your face—that's what makes these polytrauma injuries. They're not the sum of their parts; they're much worse.'" See this issue's "Faculty Focus" for more on Rosen's work.
Have you ever wondered if there's anything to the
"proliferation of products, mostly hawked over the
internet, that promise to help turn the last bit of
untrammeled downtime (sleep) into an opportunity
for self-improvement?" The New York Times
apparently has and recently explored "sleep-learning."
The sleep specialists they
consulted were uniformly dubious.
"Unlike the hypnotized
brain, which is receptive to spoken
suggestions, the sleeping
brain is not so suggestible, said
Dr. Michael Sateia, the head of the
sleep disorders program at Dartmouth.
'Generally,' he explained, 'sleep is considered
to be a state of being relatively "offline,"
as it were, with respect to extrasensory input.'"
"A protein that signals the onset of the deadliest form of breast cancer has been isolated by a team of New Hampshire scientists," reported Newsday. "'These patients are at very high risk of recurrence,' said James DiRenzo, a Dartmouth assistant professor of pharmacology. . . . DiRenzo said more work must be conducted to confirm the discovery" of the biomarker, known as nestin. Agence France Presse also covered the finding, noting that eventually, "if a noninvasive test could be devised to detect nestin, the protein could be used to screen for women at risk for this type of cancer."
Growing concern nationwide about variation in
the quality of colonoscopies was the subject of a
recent article in the New York
Times. "Last spring," the article
noted, a task force of representatives
from two gastroenterology
societies "recommended that
doctors track their polyp-detection
rate. . . . But most have not
adopted the recommendation.
Still, Dr. Douglas Robertson, a gastroenterologist at
Dartmouth and the VA Medical Center in
White River Junction, Vt., said it did not hurt to ask for a doctor's detection rate. 'If you are met with a total blank stare,' Robertson said, 'that tells you the doctor is really not clued in to quality issues and is not listening at national meetings.'"
A Dartmouth study comparing two methods of
treating post-traumatic stress disorder (PTSD) in
women received widespread media
attention. "Women are nearly
three times more prone [to
PTSD] than men, and the incidence
is particularly high among
women who have served in the
military," reported Reuters. And
NPR Morning Edition host Joe
Shapiro noted that the study involved "a team of
50 therapists who treated nearly 300 women." It
compared general psychotherapy with prolonged
exposure— which DMS's Paula Schnurr, a researcher
at the VA National Center for PTSD in White
River Junction, Vt., described as focusing "repeatedly
and vividly on a traumatic experience,
. . . retelling it in a safe context [and] eventually learning that the feared memory . . . is no
longer as frightening." Host Shapiro explained
that "after 10 weeks of exposure
therapy, the results were striking—41% had
their symptoms go away, compared to only
28% who got the usual therapy." See here
in this issue for more on Schnurr's study.
There has been much debate about the effect
of public "report cards" on medical outcomes—whether, as the
Wall Street Journal put it,
they "boost the quality of
health care, . . . don't have
much effect, good or bad,
. . . [or have] unwelcome,
unintended consequences,
such as encouraging doctors
and hospitals to game the system by
avoiding sicker patients." The article noted
that in northern New England, "heart surgeons
have been sharing performance data
privately since 1987. Quality has improved
. . . without sharing details publicly. The absence
of public report cards bred 'a spirit of
collaboration instead of a spirit of paranoia,'
says Dr. William Nugent, a heart surgeon at Dartmouth.
But seeing the national trend, the
consortium plans soon to release results publicly—by hospital, not by surgeon."
Two Dartmouth experts were asked to weigh
in on the subject of flu shots. "The flu season
has been relatively mild so far this year,"
noted the New York Times in December,
"making a flu shot seem less urgent. 'There's
so many people out there that need it and
[that] we know didn't get
it yet,' said Dr. Henry Bernstein
[pictured], a pediatrician
at Dartmouth and a member
of the infectious disease
committee of the
American Academy of Pediatrics."
By February, the
Wall Street Journal was reporting on the formulation
of next year's vaccine, including a
change urged by the World Health Organization
(WHO). "'I'm very much concerned
about the new strains that have appeared so
recently,' said Dr. John Modlin, a pediatrics professor
at Dartmouth. He said going against
the WHO recommendation would create
'real issues in terms of supply.' " Modlin is
past chair of the national Advisory Committee
on Immunization Practices.
Dr. Jonathan Ross (pictured), a general internist at DHMC, and two residents in
medicine—Drs. Osei Bonsu and Jennifer Quinn—were featured
on a recent "Medical Mysteries" segment on
ABC-TV's Primetime. The case concerned
Diana—a New Hampshire llama farmer and
former smoker with food allergies—who noticed
a sharp pain in her ear and a loss of
hearing. Viewers were asked to guess
whether the patient was suffering from "A,
nutritional deficiency; B, infection, maybe
something from the llamas; C, cancer; or D,
circulatory disease." The show quoted Ross
as having observed that
"she had a very, very restricted
diet" and so "when
I met with the housestaff
that morning, I said, 'I
think she has scurvy.' "
Quinn stated on the show
that her response was
"You've got to be kidding," and Bonsu said,
"We all looked at each other in shock." So,
concluded host Jay Schadler, "if you chose
option A, nutritional deficiency, you were
right. Diana had scurvy, vitamin C deficiency,
because of her limited diet."
A front-page article in the New York Times's "Thursday Styles" section had some advice about "When it's O.K. to run hurt." The lead ran like this: "Just before the end of last year, a prominent orthopedic surgeon was stretching to lift a heavy box and twisted his back. The pain was agonizing. He could not sit, and when he lay down he could barely get up. So the surgeon, Dr. James Weinstein of Dartmouth, decided to go out for a run." The article went on to describe why Weinstein and many other doctors now "say most people can continue with the sport they love," despite an injury. Though of course he bases his advice on more than his own personal situation, Weinstein told the Times that after his post-injury run, "he felt 'pretty good.'"
A concept called micropractice is gaining
favor with doctors, says the Wall Street Journal.
One technique that helps them do more
with patients and less with paperwork is "a
free web survey called
'How's Your Health.' Developed
by Dr. John Wasson of
Dartmouth, the 10-minute
survey is a series of carefully
formulated multiplechoice
questions about the
patient's symptoms, medications,
diet, past tests, emotional issues,
and habits, such as smoking and drinking."
See more about Wasson's work in this issue's "Grand Rounds" and at www.howsyourhealth.org.
"Time to bring back bloodletting?" That was
the headline on an MSNBC story about a
study by "researchers at the White River
Junction, Vt., VA Medical Center and Dartmouth
Medical School [that] looked at
1,277 men and women ages 43 to 87 who
had peripheral arterial disease. . . . Blood was
drawn to promote iron reduction at sixmonth
intervals from some of the patients
but not from others." Among the "younger
patients, aged 43 to 61,
[there were] fewer deaths
from all causes in the ironreduction
group, and also
fewer nonfatal heart attacks
and strokes." The results
" 'support the theory
that vascular health might
be preserved into later life by maintaining
low levels of iron over time,' said lead author
Dr. Leo Zacharski." The finding was also reported
in the Los Angeles Times, which noted
that "excess iron in the blood is thought
to promote free-radical damage to arteries."
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