MRSA Study Highlighted in WSJ Op-Ed

The Centers for Disease Control recently described the complex problem of antibiotic resistance and the potentially catastrophic consequences of inaction.1 In response, Platt co-authored a description of the Institute’s research addressing one of the most important resistant bacteria, methicillin resistant Staph. aureus (MRSA). The REDUCE MRSA trial 2 is a collaborative effort involving the Harvard Pilgrim Health Care Institute, the University of California at Irvine, the CDC, and the Hospital Corporation of America. The trial showed that treating all patients admitted to intensive-care units with antimicrobial soap and nasal ointment reduced the number of bloodstream infections caused by MRSA and other bacteria by 44%. The study used a pragmatic cluster randomized design involving over 40 hospitals and 75,000 patients, allowing the investigators to obtain these results more quickly and less expensively than is usually possible.
 
The study3 highlights the potential to create the best scientific evidence for practice when the government, academia, and the private sector work together.
 
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References
 
1.  Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2013. Atlanta: CDC; 2013. Available from: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf.

 

2.  Huang SS. et al. Targeted versus Universal Decolonization to Prevent ICU Infection. N Engl J Med 2013;368:2255-2265.

 

3. Perlin JB, Platt R. A Big Step in the Fight Against Superbugs. September 25, 2013. http://online.wsj.com/article/SB10001424127887324492604579083742106373398.html.

Fellow’s Research on Stress Featured in TED Talk

In her TED Talk, Stanford University psychologist Kelly McGonigal states that throughout her career she has advised her patients to rid stress from their lives because it can have a negative impact on the human body – she has made stress the ‘enemy’.  However, recent work by Lauren Wisk, PhD, and her colleagues has her revising her approach to stress.

Described in a 2011 American Psychological Association article, Dr. Wisk’s team linked survey data on nearly 30,000 US adults to national death records in order to determine the relationship between levels of stress, the perception that stress impacts health and health outcomes. They found that both higher levels of reported stress and the perception that stress affects health were independently associated with worse physical and mental health.

Most strikingly, those who reported a lot of stress and that stress greatly impacted their health together had a 43 percent increased risk of premature death (over an eight year period), suggesting that how you think about stress matters just as much as how much stress you have.

When you change your mind about stress you can change your body’s response to stress.  The presenter suggests that when stress is viewed as a positive, something helpful to performance, a person will be able to decrease the negative effects of stress on physical health.

TED, a nonprofit organization devoted to “ideas worth spreading”, sponsors a conference series of inspiring presentations which have attracted a global audience. TED conferences bring together the world's most fascinating thinkers and doers, who are challenged to give the talk of their lives (in 18 minutes or less).

Click here to access the study abstract in Health Psychology, the journal of the American Psychological Association.

 

Assisted Living Not Always the Answer

Interviewed along with other medical and healthcare experts, Muriel Gillick, MD states that 50-65% of those living in assisted-living communities have moderate or later-stage dementia, a number that has risen in recent decades due to the increased use of home-care services.  But is assisted-living really the answer ?
 
Dr. Gillick, a physican who specializes in the care of patients with advanced illness (palliative care) or age (geriatrics), challenges conventional thinking about the usefulness of assisted-living communities. Because a large percentage of individuals in assisted-living now have cognitive impairment, these facilities may not be able to care for them adequately. 
 
The goal of the assisted-living model is to maintain independence and privacy, However, according to Dr Gillick, author of several books including The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies and Lifelines: Living Longer, Growing Frail, Taking Heart, these patients have poor executive functioning, i.e., can’t plan, organize, and need to be constantly reminded of what is going on around them or what they are doing, and are much too impaired to live independently.  Indeed, how to balance the issues of independence and privacy with the provision of necessary, quality health care is clearly a challenge.
 
To read the Harvard Magazine article, click here.

 

Institute of Medicine Report on Cancer Care Released

The cancer care delivery system in the U.S. faces an impending crisis.  With the increase in the population of adults over the age of 65, the section with the most cancer diagnosis, and a shrinking cancer care workforce too small to care for all the new cases, the stress on the delivery system may negatively impact the quality of care cancer patients and their families receive.  Additionally, cancer and its treatments have grown in complexity, and it is often difficult for clinicians and patients to formulate high-quality care plans quickly and precisely. As a result, decisions about cancer care are often not evidence-based. 
 
The new IOM consensus report, “Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis” seeks to address these issues and offer recommendations to improve cancer care delivery.  Larissa Nekhlyudov, MD, MPH, Associate Professor, served as an expert on the committee.  The report recommends ways to respond to these challenges and improve cancer care delivery, including strengthening clinicians’ core competencies, shift to team-based models of care, and communicating more effectively with patients.
 
To address the major disparities minority groups, including low socio-economic status, racial/ethnic minorities and elderly, encounter when seeking access to cancer care, the federal government should develop national strategies utilizing community interventions to provide accessible care.  The report states the Patient Protection and Affordable Care Act is expected to make significant changes in accessibility and affordability of care, and that these issues will need to be revisited once its impact is known. 
 
To read the entire report online click here.

 

Longer Duration of Breastfeeding Shows Benefit to Child Cognition

In a prospective study of over 1,300 mother-child pairs enrolled in Project Viva, child cognition was assessed at 3 and 7 years of age using standardized assessment tools to examine any relationship to breastfeeding duration and exclusivity. Maternal fish intake during lactation was also evaluated to explore possible effects of diet on breastfeeding/cognition associations. 

Results indicated that longer breastfeeding duration was associated with greater receptive language skills at age 3 and higher intelligence at age 7.  Additionally, at the age 3 assessment, the children of mothers whose diet included 2 or more servings of fish per week performed better in visual-motor skills than those whose mothers consumed less than 2 servings per week.

Senior author Emily Oken, MD, MPH, believes examining the relationship between breastfeeding and cognitive development is important because few studies have quantified breastfeeding duration and exclusivity, or have explored the potential effect of the diet of breastfeeding mothers.

 

High Deductible Health Plan Study Featured in NYT “Your Money”

In a recent New York Times “Your Money” column, DPM researcher Frank Wharam, MB, BCh, BAO, MPH discusses the results of his recently published Medical Care article, which found that of subscribers in high-deductible health care plans, men are more likely than women to avoid necessary medical care.  Since the Affordable Care Act is expected to increase the number of people enrolled in high-deductible plans, enrollment in plans that have high out-of-pocket costs could further reduce use of health care services among men.

The NYT columnist reflects on the gender differences cited in Dr. Wharam’s study and offers men on high-deductible plans some questions to consider when deciding to seek medical care.  Alison Galbraith, MD, MPH, also a contributor to the article, suggests men engage their physicians in conversation about the cost of medical care, and whether cheaper, alternative treatments are available.

To read the full New York Times article, click here.

To read Dr. Wharam’s study abstract, click here.

Increased risk of intussusception following rotavirus vaccination in infants

Rotavirus infection causes diarrheal disease, mostly in infants, and was associated with more than 600,000 deaths each year globally prior to the availability of vaccine.  Rotashield, an infant rotavirus vaccine licensed in 1998, was voluntarily withdrawn from the market within a year when an increased risk of intussusception, a rare kind of intestinal blockage, after vaccination was discovered.  Two newer rotavirus vaccines, RotaTeq and Rotarix, were licensed in the U.S. in 2006 and 2008, respectively, after large clinical trials designed to be able to detect an excess risk of intussusception similar to that of Rotashield (approximately 1-1.5 excess cases per 10,000 vaccine recipients).  Although no such risk was observed in the clinical trials, several postlicensure studies conducted in other countries subsequently suggested an increased risk of intussusception after both Rotarix and RotaTeq. 
 
In 2010, the FDA, through Mini-Sentinel’s Post-licensure Rapid Immunization Safety Monitoring (PRISM) project, launched a large population-based study to quantify the risk of intussusception after rotavirus vaccination among U.S. infants. The study, led by Katherine Yih, PhD, MPH, found evidence of an association between one of the rotavirus vaccines, RotaTeq, and intussusception, with the highest risk occurring in the 3-7 days after the first dose.  The risk was estimated at approximately 1.1-1.5 excess cases per 100,000 first-dose recipients, or about 1/10 the risk associated with the original, discontinued vaccine, Rotashield.  Based on published data, the benefit of the vaccine in preventing hospitalizations and deaths from diarrheal disease continues to outweigh the risk of intussusception.  
 
As a result of this study, the FDA approved a change to the RotaTeq product label.  Dr. Yih presented the findings to the Advisory Committee on Immunization Practices (ACIP) in June, which is evaluating them together with results of other recent studies but does not foresee major changes in rotavirus vaccination policy.
 
The full report is posted to the Mini-Sentinel Website.
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