Discoveries

Research Briefs

Diabetes dangers
Diabetes, which affects 11% of Americans over the age of 20, carries all sorts of complications. A recent study by DMS researcher Todd MacKenzie, Ph.D., may have found yet another complication. The study, published in the journal Cancer, found that individuals with diabetes were twice as likely to develop bladder cancer as individuals without diabetes. The link grew even stronger over time; people who'd had diabetes for 16 years or more were three and a half times as likely to develop bladder cancer. Diabetics who used oral medications to control their blood sugar rather than just monitoring their diet also had a much higher risk.

In good hands
Good hand hygiene is key to health in everyday life, and it's critical to patient health in intensive care units. Even seemingly small changes in hand-hygiene procedures, like giving ICU staff a personal hand-sanitizer unit that they can attach to their clothing, can reduce infections among patients. So found a recent study published in the Journal of Critical Care by a team of DH anesthesiologists. The incidence of ventilator-associated pneumonia decreased by 50% after the introduction of such dispensers, although the rate of central line catheterrelated infections remained the same.

Communities that have more doctors who practice primary care are likely to have healthier senior citizens, concluded a DMS study published in the Journal of the American Medical Association.

Too much surgery? Who nose . . .
Endoscopic sinus surgery (ESS) is on the rise among the elderly, and the per capita rate of the procedure varies widely from place to place, according to a paper by DH otolaryngologist Giridhar Venkatraman, M.D. "Variability in high-use versus low-use regions seems to be random and independent of climate or the number of beneficiaries diagnosed as having chronic rhinosinusitis," he and his coauthors wrote in Archives of Otolaryngology. Per capita ESS rates ranged from 2 to 10 surgeries per 100,000 Medicare beneficiaries. This points to "the need for identifying and adopting more rigorous clinical criteria for ESS," they concluded.

Weight, weight . . . don't tell me
Depression and obesity often go hand in hand in the elderly, Dartmouth's Laura Barre, M.D., has found. She determined that among patients in their sixties, seventies, and eighties, the incidence of depression rises with body mass index. About 17% of elderly people who are obese are depressed, compared with only about 11% of those of normal weight. Barre's study did not prove that obesity causes depression (or vice versa), but it did establish a correlation between the conditions. She presented her findings at the annual meeting of the American Association for Geriatric Psychiatry.

An editorial in Nature by DMS's Michael Sporn, M.D., called on clinical oncologists to reexamine the concept of chemoprevention and on regulators to better accommodate chemoprevention trials.

Test-imony
A rise in the incidence of pulmonary emboli, blockages in the arteries that carry blood from the heart to the lungs, may be overdiagnosis, says a DMS team. In 1998, a new CT scan was able to better detect such blockages; in succeeding years, their incidence jumped 81%—but the death rate from the condition stayed about the same, and complications associated with treatment rose 71%. "Many assumed this highly sensitive test would improve outcomes," the team wrote in Archives of Internal Medicine. But "the increased sensitivity . . . may have a downside: the detection of emboli that are so small as to be clinically insignificant."

Safe sedation
When children need anesthesia, are they safer in the hands of an emergency physician, a pediatrician, an anesthesiologist, or some other specialist? It turns out it doesn't matter who provides sedation, according to a paper coauthored by two DH anesthesiologists. Sedation performed outside versus inside an operating room "is unlikely to yield serious adverse outcomes," they wrote. The study, published in Pediatrics, found that there was no greater risk of complications when a child was sedated by one type of clinician over another, as all had similarly low complication rates.

The Dartmouth Immunology COBRE (Center of Biomedical Research Excellence), a cross-disciplinary effort to better understand the immune system, has $6 million in new funding.