Surgery trumps physical therapy, education, exercise, and medicine when it comes to relieving pain and improving physical function in people with a herniated lumbar disc. So reported James Weinstein, D.O., and his colleagues in the December 2008 issue of Spine. "The treatment effect for surgery was seen as early as six weeks, appeared to reach a maximum by six months, and persisted over four years," they wrote. The group of patients who didn't have surgery improved, too, the authors noted, just not as much as the group who had surgery.
DMS researchers found a possible link between maternal cigarette use and Sudden Infant Death Syndrome (SIDS). SIDS is a major cause of infant mortality in the U.S., but its mechanisms are still unknown. One possibility is laryngeal chemoreflex apnea, a condition in which liquid in the larynx may cause infants to stop breathing. The DMS study showed that apnea lasted longer in rat pups whose mothers had been exposed to tobacco smoke than in rat pups from unexposed mothers. "This finding may be significant for the pathogenesis of SIDS in human infants," wrote Luxi Xia, M.D., and her coauthors in Respiratory Physiology and Neurobiology.
When more is less
For chronically ill patients, spending more time in the hospital is associated with lower quality-of-care and patient satisfaction scores, reported DMS researchers. The group compared quality and satisfaction in regions with a high intensity of hospital care to regions with a low intensity of hospital care. "The common thread linking greater care intensity with lower quality and less favorable patient experiences may be poorly coordinated care," wrote John Wennberg, M.D., et al. in Health Affairs. Patients from high-intensity regions cited "dirty rooms, noisy nighttime, poor pain control, and shortfalls in communication with doctors and nurses" as reasons for low ratings.
Veterans in need of mental health care at the DMS-affiliated VA Medical Center in White River Junction, Vt., used to have to wait an average of 33 days to see a specialist. Now the average wait time is 19 minutes. So reported a team that implemented a new model of care, making mental health specialists immediately available in a primary-care clinic. "The primary mental health clinic dramatically enhanced access to mental health care . . . while doubling clinician productivity," Andrew Pomerantz, M.D., et al. wrote in General Hospital Psychiatry.
Albuterol, an asthma medication, may contribute to acid-reflux attacks, according to a DMS study. The study, published in Digestive Diseases and Sciences, found that repeated use of albuterol may reduce pressure in the lower esophageal sphincter (LES). The LES normally prevents stomach acids and enzymes from entering the esophagus, so decreased LES pressure may "raise the possibility that gastroesophageal reflux may occur after broncho-dilator therapy," wrote Brian Lacy, M.D., et al., suggesting that changes in LES pressure could be the link between asthma and gastroesophageal reflux disease.
A common ingredient in cosmetics, foods, and drugs-an emulsifier called polysorbate 80 (PS80)-inhibits the colonization of bacteria on a variety of surfaces, a DMS team recently found. About 80% of health-care--associated infections are caused by bacteria in the form of biofilms-the very structure that PS80 breaks down. "Potential clinical applications of the antibiofilm effect of PS80 or derivatives include the treatment of medical prosthetic devices, such as artificial joints and intraocular lenses, prior to implantation," wrote Michael Zegans, M.D., and his coauthors in Anti-microbial Agents and Chemotherapy.
Dartmouth neurologist James Bernat, M.D., gave the keynote lecture at the 2008 annual meeting of the Vlaamse Vereniging voor Neurologie, the Flemish Neurological Society, in Antwerp, Belgium.
In certain subsets of individuals, including women and moderate smokers, the trace mineral selenium may help prevent bladder cancer, determined a recent Dartmouth study.
Dr. Joyce DeLeo, the chair of Pharmacology and Toxicology, was recently quoted in Nature Biotechnology about progress in studying glial cells; she's worked in the field since the 1980s.
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