Severity of emphysema, as measured by computed tomography (CT), is a strong independent predictor of all-cause, cardiovascular, and respiratory mortality in ever-smokers with or without chronic obstructive pulmonary disease (COPD), according to a study from researchers in Norway. In patients with severe emphysema, airway wall thickness is also associated with mortality from respiratory causes.
‘Ours is the first study to examine the relationship between degree of emphysema and mortality in a community-based sample and between airway wall thickness and mortality,’ said lead author Ane Johannessen, PhD, post-doctoral researcher at Haukeland University Hospital in Bergen, Norway. ‘Given the wide use of chest CT scans around the world, the predictive value of these measures on mortality risk is of substantial clinical importance.’
The study included a community-based cohort of 947 ever-smokers with and without COPD who were followed for eight years. All subjects underwent spirometry and CT scanning. Degree of emphysema was categorised as low, medium, or high based on the percent of low attenuation areas (areas with lower density than normal) on CT. COPD was diagnosed by spirometric measurement of airway obstruction. Of the 947 patients, 462 had COPD.
During follow-up, four percent of the 568 subjects with a low degree of emphysema died, compared with 18 percent of the 190 patients with a medium degree of emphysema and 44 percent of the 189 patients with a high degree of emphysema.
After adjustment for sex, COPD status, age, body mass index, smoking and measures of lung function, survival in the low emphysema group was 19 months longer than survival in the middle and high emphysema groups for all-cause mortality. Compared with subjects in the low emphysema group, subjects with a high degree of emphysema had 33 months shorter survival for respiratory mortality and 37 months shorter survival for cardiovascular mortality.
Emphysema was a significant predictor of all cause-specific mortalities, with increasing emphysema levels predicting shorter survival. While airway wall thickness was not an independent predictor of mortality, increased airway wall thickness reduced survival time in patients with more severe emphysema.
‘The relationship between emphysema levels and mortality we found can be used in the risk assessment of these patients,’ concluded Dr. Johannessen. ‘Accurately predicting mortality risk may help target patients for specific therapeutic interventions which may improve outcomes.’ EurekAlert

Severe and life-threatening complications in pregnancy can have a big impact on fathers as well as mothers.
That’s one of the key findings of work by Oxford University researchers who spoke to couples who had been through this, in compiling a new resource for the award-winning patient website www.healthtalkonline.org.
The new pages covering life-threatening conditions in childbirth and pregnancy have just been launched.
Other points that emerged from the interviews included the huge difference that little examples of thoughtful care from doctors and midwives could make to how couples coped when emergency care was needed around the time of the birth of their child.
Examples included an anaesthetist who stepped out of theatre to show the waiting father a photo of his new baby on an iPhone; staff who kept a diary of the newborn baby’s day in a neonatal unit that was in a different hospital to the mother; and a midwife who greeted a woman with major bleeding arriving in an ambulance with a monitor so she could hear her baby’s heartbeat and know nothing had happened to him.
Severe complications in labour and childbirth aren’t common. But perhaps because of this, there can be difficulties for couples in getting the support they might need or finding others that have gone through similar experiences. And for doctors and midwives who don’t see many such cases, they may not be aware of what follow-up care could help. Oxford University

Most people know a colonoscopy requires some preparation by the patient. Now, a Mayo Clinic physician suggests an additional step to lower the risk of colorectal cancer: Ask for your doctor’s success rate detecting easy-to-miss polyps called adenomas.
The measure of success is called the adenoma detection rate, or ADR, and has been linked to a reduced risk of developing a new cancer after the colonoscopy. The current recommended national benchmark is at least 20 percent, which means that an endoscopist should be able to detect adenomas in at least 1 of 5 patients getting a colonoscopy.
Recently, the Mayo Clinic in Florida developed a two-hour course designed to increase a doctor’s ADR rate in order to reduce development of colorectal cancer.
They found the short course made a big difference in even experienced endocopsists, the physicians who perform colonoscopies.
‘Numerous studies have shown that increased detection and removal of potentially pre-cancerous polyps lowers the incidence of colorectal cancer,’ says Michael Wallace, M.D., M.P.H., chair of the Division of Gastroenterology and Hepatology at Mayo Clinic in Florida. ‘We also know that there is a lot of variability in how proficient physicians are at finding those polyps.’
A team of Mayo physicians and researchers led by Dr. Wallace, has long been working to help endoscopists better detect polyps.
Dr. Wallace and his team developed a two-hour training course that describes polyps that can be difficult to see, such as flat lesions, but are often the most dangerous.
The research team turned to Mayo Clinic endoscopists to study whether the course helps. Researchers first looked at the adenoma detection rate in 15 physicians and found it was 35 percent

A hospital is not the best place to get a good night

In one of the largest observational studies of its kind, researchers report that a combination of chemotherapy and radiation followed by surgery in patients with stage 3 non-small cell lung cancer improves survival.

Patients who had chemoradiation therapy followed by surgery had twice the five-year survival rate of those who had only chemoradiation, says Dr. Matthew Koshy, a radiation oncologist at the University of Illinois Hospital & Health Sciences System and lead author of the study.

The study looked at various treatment strategies in an effort to identify the best option for overall survival. The researchers used the National Cancer Database to identify 11,242 adult patients ages 19 and older who were treated for stage 3 non-small cell lung cancer between 1998 and 2004.

Treatment strategies used against this form of lung cancer include chemoradiation therapy; chemoradiation followed by surgery; and surgery followed by chemoradiation.

‘The role of chemoradiation therapy followed by surgery is somewhat controversial, because previous clinical studies have not shown a clear survival benefit,’ said Koshy, who noted that the practice of using chemotherapy and radiation to reduce the extent of cancer prior to surgery was begun in an effort to improve poor survival rates in this group of patients.
Dr. Matthew Koshy, radiation oncologist, University of Illinois Hospital & Health Sciences System

The new study found that five-year overall survival was 34 percent for patients who received chemoradiation therapy followed by surgery to remove a lobe of the lung, 20 percent for patients who had the surgery followed by the adjuvant therapy, and 13 percent for patients who received chemoradiation therapy but no surgery.

The researchers say that additional prospective studies are needed to confirm the benefit of chemoradiation prior to surgery and define the standard of care for patients with stage 3 non-small cell lung cancer.

‘The main message to patients,’ Koshy said, ‘is to seek care from a multidisciplinary group of physicians that includes a thoracic surgeon, medical oncologist and radiation oncologist who can work together to determine the most appropriate initial treatment strategy.’ The University of Illinois Hospital & Health Sciences System