1. iPad app that allows patients to order tests doubles colon cancer screening rates in study
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2315
URLs go live when the embargo lifts
An iPad app that educates patients about different options for colon cancer screening and allows them to order their preferred test may increase screening rates. The findings of a randomized controlled trial are published in Annals of Internal Medicine.
Screening for colon cancer has been proven to reduce mortality, yet more than one third of eligible Americans remain unscreened. Researchers from Wake Forest School of Medicine sought to determine if a digital health intervention delivered via iPad app could increase screening rates.
Researchers enrolled 450 patients in primary care who were due for colon cancer screening and agreed to participate in the study. The participants were randomly assigned to colon cancer education through the iPad app or usual care. Patients using the iPad app were educated about different types of screening tests and could order the test they wanted. Patients in both groups took a brief survey about colon cancer screening. Patients who received education and reminders through the app were twice as likely to undergo screening compared to patients in the usual care group (30 percent versus 15 percent, respectively).
The authors of an accompanying editorial from the Center for Health Care Innovation at the University of Pennsylvania caution that the study was limited to primary care patients who had already agreed to participate in the research, which means that the results may not translate to a broader population. They suggest that improvements in colon cancer screening will more likely arrive incrementally from compound interventions that involve technology, education, and behavior.
Media contact: For an embargoed PDF or to interview with the lead author, David Miller, Jr. MD, MS, please contact please contact Marguerite Beck at marbeck@wakehealth.edu.,/p>
2. Colonoscopy significantly reduces mortality from colorectal cancer in Veterans Affairs study
Abstract: http://annals.org/aim/article/doi/10.7326/M17-0723
URLs go live when the embargo lifts
Colonoscopy was associated with a 61 percent reduction in colorectal cancer mortality among veterans receiving care through the Veterans Affairs (VA) health system. The reduction was observed for both left- and right-sided colorectal cancer, although the association was weaker for right-sided cancer (46 percent versus 72 percent reduction). The findings are published in Annals of Internal Medicine.
Colonoscopy is widely used in the VA health care system, where it is endorsed as a primary colorectal cancer screening option for average-risk patients aged 50 and older. Despite its increased use, it is not known whether colonoscopy decreases colorectal cancer mortality among veterans and whether the effect varies based on the anatomical location of colorectal cancer.
A team of researchers from the VA Medical Centers in Indianapolis and White River Junction (affiliated with Indiana University School of Medicine and Geisel School of Medicine in Dartmouth) reviewed VA-Medicare administrative data, and identified 4,964 case patients who were diagnosed with colorectal cancer between 2002 and 2008 and died of the disease by the end of 2010. Case patients were matched to 4 control patients (n = 19,856) without prior diagnosis of colorectal cancer. Exposure to colonoscopy was determined from 1997 to 6 months before colorectal cancer diagnosis in case patients and to a corresponding date in control patients. Subgroup analysis was performed for patients who had undergone screening colonoscopy.
The researchers found that the patients who died of colorectal cancer were significantly less likely to have undergone any colonoscopy. Colonoscopy was associated with reduced mortality for left-sided cancer and right-sided cancer, although the reduction was smaller for right-sided cancer. The authors suggest that reducing variability in colonoscopy effectiveness, particularly against right-sided colorectal cancer, is critical for effective disease prevention.?
Media contacts: For an embargoed PDF, please contact Angela Collom. To interview lead author, Charles J. Kahi, MD, MSc, please contact Michael Schug at maschug@iupui.edu or 317-278-0953. To interview lead author, Heiko Pohl, MD, please contact Jaime A. Peyton, MBA at Jaime.A.Peyton@dartmouth.edu or 603-653-3615.
3. Bronchial thermoplasty may be a viable treatment option for patients with severe asthmatic cough
Abstract: http://annals.org/aim/article/doi/10.7326/L17-0748
URLs go live when the embargo lifts
Bronchial thermoplasty, a novel treatment for severe asthma, may be a viable treatment option for patients with severe asthmatic cough who have not responded to more conventional therapies. A brief case report is published in Annals of Internal Medicine.
Researchers from Nagoya City University in Nagoya, Japan report the case of a 34-year-old woman with asthma and a 2.5 year history of chronic cough. Despite treatment with high-dose inhaled corticosteroids, long-acting β2-agonists, and leukotriene-receptor antagonists, the patient's cough had worsened and was awakening her at night and disturbing her conversations.
Since all conventional treatments seemed to fail, the researchers used bronchial thermoplasty to treat all visible bronchi. The patient had three procedures at 3-week intervals. The cough improved immediately after the first procedure. Three months after the final procedure, the patient had improved in frequency, cough-related quality of life, and asthma control. The number of capsaicin-induced coughs also decreased, but measures of systemic eosinophilic and airway inflammation and pulmonary function remained unchanged. The authors conclude that bronchial thermoplasty should be considered in patients with severe asthmatic cough who have not responded to traditional therapeutic approaches.
Media contacts: For an embargoed PDF, please contact Angela Collom. The lead author, Yoshihiro Kanemitsu, MD, PhD, can be contacted directly at kaney32@med.nagoya-cu.ac.jp.
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Also new in this issue:
Engaging Survivors of Human Trafficking: Complex Health Care Needs and Scarce Resources
Abigail M. Judge, PhD; Jennifer A. Murphy, PhD; Jose Hidalgo, MD; Wendy Marcias-Konstantopoloulos, MD, MPH
Medicine and Public Issues
Abstract: http://annals.org/aim/article/doi/10.7326/M17-2605
Human Trafficking: A Health and Human Rights Agenda
Arianne M. Lachapelle Henry, BA; Michael A. Grodin, MD
Editorial
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0357
Journal
Annals of Internal Medicine