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Week of August 15, 2011

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Use of CT scans in ERs increased 330 percent in 12 years

A review of national data from 1996 through 2007 reveals a sharp uptick in the use of computed tomography, or CT, scans to diagnose illnesses in emergency departments (ED), a U-M Health System study finds. The rate of CT use grew 11 times faster than the rate of ED visits during the study period.

The study also showed that the use of CT scans was less common early in the study period, but rose significantly over time. Just 3.2 percent of emergency patients received CT scans in 1996, while 13.9 percent of emergency patients seen in 2007 received them.

“This means that by 2007, 1 in 7 ED patients got a CT scan,” says first author Dr. Keith Kocher, a clinical lecturer in the Department of Emergency Medicine. “It also means that about 25 percent of all the CT scans done in the United States are performed in the ED.”

Using data from the National Hospital Ambulatory Medical Care Survey, compiled by the Centers for Disease Control, the researchers reviewed 1.29 billion weighted records of emergency visits between 1996 and 2007, 97.1 million of which included patients who received a CT scan. Their findings were published online ahead of print publication in the Annals of Emergency Medicine and highlighted as a featured article.

The number of emergency patients receiving CT scans increased the most from 1996 to 2007 among patients with abdominal pain, flank pain, chest pain and shortness of breath. Rates of CT use rose most dramatically among older adults.

Additional authors are Dr. William Meurer and Dr. Phillip A. Scott, of U-M; and Dr. Brahmajee Nallamothu, of U-M and the VA Ann Arbor Healthcare System.

Poll: Half of Michigan’s local officials say state on the wrong track

Half of the local government officials surveyed in Michigan say the state is generally on the wrong track, while 32 percent think the state is going the right way, a new U-M poll says.

Democratic officials were most likely to be critical of the state’s direction. But even among local Republican officials, fewer than half (46 percent) believe the state is going the right way, the poll says.

The statewide survey was conducted as part of the ongoing Michigan Public Policy Survey by the Center for Local, State, and Urban Policy (CLOSUP) at the Gerald R. Ford School of Public Policy.

“Local governments are key players in implementing state-level policy decisions, so this high level of concern about the state’s direction among local officials should be on the radar for the governor and state legislators,” says Brian Jacob, professor of public policy and director of CLOSUP.

“Local officials know the conditions on the ground, where the policy rubber meets the road, so their views can provide important guidance to state policymakers. Ideally we would see a higher level of alignment in the views of our state and local policymakers.”

In the first half of 2011, significant policy changes have reshaped the relationship between Michigan’s state and local governments. Major developments include the new emergency manager law and revenue sharing changes to incentivize local government reform.

“This study finds mixed-reactions among Michigan’s local government leaders to these changes,” Jacob says.

There was also a change in the governor’s office, with Republican Rick Snyder replacing Democrat Jennifer Granholm.

Local officials are divided about Snyder’s job performance, with 37 percent rating him as good or excellent and 22 percent giving him a poor rating, the survey says. Unsurprisingly, Republicans are more supportive of Snyder, but only a bare majority of them (52 percent) say his performance was either good or excellent.

Sentinel node biopsy safe, effective in head and neck melanomas

A common technique for determining whether melanoma has spread can be used safely and effectively even in tumors from the head and neck area, according to a new study from the Comprehensive Cancer Center.

Sentinel lymph node biopsy involves injecting a special dye to identify the first node where cancer likely would spread. If that node is clean, patients can avoid further debilitating surgery to remove multiple lymph nodes. If that node shows cancer, patients know they need the more extensive surgery or further treatment with radiation, chemotherapy or a clinical trial. Patients with larger melanomas are routinely offered this procedure.

But many surgeons believed that the complex anatomy combined with the critical nerves and blood vessels in the head and neck area made sentinel lymph node biopsy unsafe and inaccurate for melanomas in that region.

In the current study, which appears online in Cancer, researchers found about 20 percent of the patients had at least one sentinel node positive for cancer and were referred for a complete dissection to remove additional lymph nodes.

Among the remaining 283 patients with negative sentinel nodes, 12 patients recurred in the region where the sentinel lymph node was identified. This suggests that the test yielded 12 false-negative results, which means a negative test was incorrect 4 percent of the time. This rate is similar when sentinel lymph node biopsy is used for melanomas in other parts of the body.

“Sentinel lymph node biopsy is a safe and effective way to determine the status of the regional nodal basin for melanomas affecting the head and neck region. Furthermore, our study showed that it can be done accurately for these patients,” says study author Dr. Carol Bradford, professor and chair of otolaryngology at the Medical School.

Additional U-M authors are Dr. Audrey Erman, Dr. Ryan Collar, Kent Griffith, Dr. Lori Lowe, Dr. Michael Sabel, Dr. Christopher Bichakjian, Dr. Sandra Wong, Dr. Scott McLean, Dr. Riley Rees and Dr. Timothy Johnson.

Men overly optimistic about recovery from prostate cancer surgery

Nearly half of men undergoing surgery for prostate cancer expect better recovery from the side effects of the surgery than they actually attain one year after the operation, a Comprehensive Cancer Center study finds.

In addition, prior to surgery, a small proportion of men had expected to have better urinary continence and sexual functions a year after the surgery than they had before it — the exact opposite of what typically happens.

“This is a belief that does not reflect preoperative counseling which, on the contrary, alerts men to urinary and sexual problems after surgery,” says study author Daniela Wittmann, sexual health coordinator at the U-M prostate cancer survivorship program.

The study, published in the August issue of the Journal of Urology, surveyed 152 men undergoing radical prostatectomy, an operation to remove the prostate.

The study showed that for the most part, men’s expectations of hormonal and bowel function matched what happened one year after surgery. But, when it came to urinary incontinence only 36 percent of the men’s expectations corresponded to what happened one year post-surgery.

In addition, only 40 percent of men found what they expected for sexual function to be true one year post-surgery.

Also, 46 percent of the men found worse than expected outcomes in urinary incontinence and 44 percent of men found worse than expected outcomes in sexual function one year after surgery.

“When we provide preoperative education, we can only inform men in terms of overall statistics. We can’t predict for the individual,” Wittmann says. “This may mean that, if in doubt, people tend toward being hopeful and optimistic, perhaps overly optimistic.”

Additional U-M authors are Chang He, Michael Coelho, Dr. Brent Hollenbeck, Dr. James Montie and Dr. David Wood Jr.

Post-traumatic stress disorder linked to smaller birth weight

Women with post-traumatic stress disorder are likely to have smaller babies and deliver prematurely, a new U-M study suggests.

Published in BJOG: An International Journal of Obstetrics and Gynaecology, the research found that mothers with PTSD who suffered abuse during childhood give birth to babies of lower-average weight and experience shorter gestation.

PTSD is prevalent among women and can occur following traumatic events such as war, disaster, childhood maltreatment, rape and battering. Women with low income and education tend to have higher rates of PTSD in pregnancy, as do African-American women.

In the study, children born to women with PTSD weighed a half-pound less than traumatized women who did not develop PTSD, and nearly a half pound less than women who were not exposed to trauma. Among childhood abuse survivors, the association of current PTSD with lower birth weight was stronger.

The research also looked at race as a risk factor for PTSD. African-American women are at no greater risk for onset of PTSD, but they are four times more likely to remain affected by the disorder at the time of pregnancy.

“Preterm birth can cause serious health problems for babies,” says Julia Seng, a research associate professor at the Institute for Research on Women and Gender and an associate professor of nursing. “An African-American infant in Michigan is 70 percent more likely to be born prematurely than an infant of any other race. Therefore, PTSD, which affects African Americans more widely, may be an additional explanation for adverse perinatal outcomes, and it is a problem that is treatable.”

The study’s other U-M authors include Lisa Kane Low, Mickey Sperlich, David Ronis and Israel Liberzon.

— Jared Wadley, News Service

Aerosols affect climate more than satellite estimates predict

Aerosol particles, including soot and sulfur dioxide from burning fossil fuels, essentially mask the effects of greenhouse gases and are at the heart of the biggest uncertainty in climate change prediction. New research from U-M shows that satellite-based projections of aerosols’ effect on Earth’s climate significantly underestimate their impacts.

The findings were published online the week of Aug. 1 in the early edition of the Proceedings of the National Academy of Sciences.

Aerosols are at the core of “cloud drops” — water particles suspended in air that coalesce to form precipitation. Increasing the number of aerosol particles causes an increase in the number of cloud drops, which results in brighter clouds that reflect more light and have a greater cooling effect on the planet.

As to the extent of their cooling effect, scientists offer different scenarios that would raise the global average surface temperature during the next century between under 2 to over 3 degrees Celsius. That may not sound like a broad range, but it straddles the 2-degree tipping point beyond which scientists say the planet can expect more catastrophic climate change effects.

The satellite data that these findings poke holes in has been used to argue that all these models overestimate how hot the planet will get.

“The satellite estimates are way too small,” says Joyce Penner, the Ralph J. Cicerone Distinguished University Professor of Atmospheric Science. “There are things about the global model that should fit the satellite data but don’t, so I won’t argue that the models necessarily are correct. But we’ve explained why satellite estimates and the models are so different.”

Penner and her colleagues found faults in the techniques that satellite estimates use to find the difference between cloud drop concentrations today and before the Industrial Revolution.

U-M, Ford researchers see plentiful lithium resources for electric vehicles

Researchers from U-M and Ford Motor Co. have assessed the global availability of lithium and compared it to the potential demand from large-scale global use of electric vehicles. The research findings, published in the current issue of the Journal of Industrial Ecology, conclude that sufficient resources of lithium exist for the next 90 years to supply a large-scale global fleet of electric vehicles through at least 2100.

The researchers compiled data on 103 deposits containing lithium, with an emphasis on 32 deposits that have a lithium resource of more than 100,000 metric tons each. Lithium is a key ingredient in the development of certain types of batteries, and is a key element of batteries used in hybrid and all-electric vehicles.

The data collected included deposit location, geologic type, dimensions and content of lithium, as well as the current status of production. Using the definition of a lithium “resource” as a deposit from which production is currently or potentially feasible economically, the researchers estimated a global lithium resource of about 39 million tons.

The study’s main authors were Paul Gruber and Pablo Medina, who both conducted the research as part of a graduate student research project before graduating in 2010 from the School of Natural Resources and Environment.

Other U-M co-authors were Gregory Keoleian, professor of sustainable systems, SNRE, and Stephen Kesler, a professor emeritus of geological sciences.

Urine test shows prostate cancer risk, U-M study finds

A new urine test can help aid early detection of and treatment decisions about prostate cancer, a study from the Comprehensive Cancer Center and the Michigan Center for Translational Pathology finds.

The test supplements an elevated prostate specific antigen, or PSA, screening result, and could help some men delay or avoid a needle biopsy while pointing out men at highest risk for clinically significant prostate cancer.

The test looks for a genetic anomaly that occurs in about half of all prostate cancers, an instance of two genes changing places and fusing together. This gene fusion, TMPRSS2:ERG, is believed to cause prostate cancer. Studies in prostate tissues show that the gene fusion almost always indicates cancer. But because the gene fusion is present only half the time, the researchers also included another marker, PCA3. The combination was more predictive of cancer than either marker alone.

Results of the study appear in the Aug. 3 issue of Science Translational Medicine.

“Testing for TMPRSS2:ERG and PCA3 significantly improves the ability to predict whether a man has prostate cancer,” says lead author Dr. Scott Tomlins, a pathology resident at the U-M Health System. “We think this is going to be a tool to help men with elevated PSA decide if they need a biopsy or if they can delay having a biopsy and follow their PSA and urine TMPRSS2:ERG and PCA3.”

“Many more men have elevated PSA than actually have cancer but it can be difficult to determine this without biopsy. This test will help in this regard,” says senior study author Dr. Arul Chinnaiyan, director of the Michigan Center for Translational Pathology and S.P. Hicks Professor of Pathology at the Medical School. Chinnaiyan also is a Howard Hughes Medical Institute researcher.

Additional U-M authors are Javed Siddiqui, Robert Lonigro, Laurie Sefton-Miller, Radhika Varambally, Bo Han, David Wood, Lei Wang, Daniel Rhodes, Brent Hollenbeck, Stephanie Meyers, Nallasivam Palanisamy and John Wei.

 

STAFF SPOTLIGHT

Mary Bagwell, laundry feeder folder, U-M Health System Laundry Services, on the key to great spaghetti: “You add a little bit of sugar or a little bit of mint to take out the bitterness.”

EVENTS

William Faulkner’s Artifacts of Authorship exhibit, 10 a.m.-5 p.m. Monday through Friday, Special Collections Library

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