News in brief - June 13, 2005

Accuracy of mammogram interpretation examined - Hot tubs a cough culprit - Depression after heart attack - Cold cure shows some promise - Rehabilitation may have benefits over surgery for resolving low back pain

Accuracy of mammogram interpretation examined

To help breast imaging facilities determine how accurately they are interpreting mammograms, the Food and Drug Administration should require the facilities to collect additional data that can be used to better measure their staffs' performance, said a new report from the Institute of Medicine.

To prepare for the anticipated reauthorization of the Mammography Quality Standards Act in 2007, Congress asked the IOM to examine whether additional steps could be taken to improve the accuracy of mammography interpretation or to enhance regulatory oversight.

Although the technical quality of mammography has improved significantly since the MQSA was passed in 1992, questions remain about the quality of mammogram interpretation, which is subjective and difficult to measure, the report said.

Hot tubs a cough culprit

Twenty-two patients who had been coughing and breathless for at least seven months were diagnosed with "hot tub lung" at a poster presentation at the American Thoracic Society's international conference held last month in San Diego.

Examinations of the patients revealed evidence of diffuse lung disease and positive Mycobacterium avium-intracellulare cultures from respiratory secretions, lung tissue or hot tub water. Other than hot tub exposure, the physicians could identify no other cause of illness.

The patients were advised to avoid hot tubs. Of the patients followed, 12 received corticosteroids and five had antimycobacterial therapy. All experienced improvements.

Depression after heart attack

One in five patients hospitalized for a heart attack develop major depression. This is associated with worse outcomes, primarily because depressed patients are less likely to take their medications as instructed or heed advice on lifestyle changes to prevent future attacks, according to a review of the literature issued by the Agency for Healthcare Research and Quality last month.

Report authors also found that about two-thirds of heart attack patients who initially develop depression continue to be depressed for months after, and counseling and antidepressants can reduce symptoms. Evidence was not sufficient, however, to suggest that therapy reduces the odds of dying from a subsequent cardiac event.

"This report provides the scientific evidence clinicians need to know about the prevalence of depression in heart attack survivors, how depression affects these patients, and the need to treat the disease early," said AHRQ Director Carolyn M. Clancy, MD.

This review was requested by the American Academy of Family Physicians. The academy plans to use the report to develop clinical practice guidelines.

Cold cure shows some promise

An antiviral compound that wiggles its way into the common cold virus may provide one piece of the solution to halting infections, according to Purdue University scientists who published their findings in the May 24 issue of the Proceedings of the National Academy of Sciences.

Using computer simulations, the scientists found that the likely reason for the promise shown by a prototype drug for curing colds, the WIN compound, is its flexible structure that may allow it to shimmy inside the proteins that form the virus' outer shell and alter them to the point where they cannot complete the infection process.

"WIN compounds aren't going to cure the cold anytime soon, but our analysis of their behavior may have shown us why they are so good at foiling these viruses. Their flexibility allows them to reach a weak spot in the viral shell," said lead author Carol B. Post, professor of medicinal chemistry in Purdue's College of Pharmacy, Nursing and Health Sciences and of biological sciences in the College of Science.

Rehabilitation may have benefits over surgery for resolving low back pain

Intensive cognitive behavioral therapy and physiotherapy can achieve results similar to surgical treatment of low back pain at a lower cost, according to a pair of studies published May 23 in the online edition of the British Medical Journal.

Researchers randomized patients who had low back pain for at least a year to receive either a lumbar spine fusion or a daily outpatient program led by a physiotherapist in conjunction with a physician and a clinical psychologist. After two years, both groups improved significantly and achieved similar reductions in disability. The patients who had surgery, however, achieved this at a greater expense to the health care system. The cost of medical care for those who had surgery was more than $14,000. The rehabilitation group cost just more than $8,000 per patient.

Spinal fusion patients did achieve marginally better results, but the authors suggest that this may not be worth the additional risks of surgery and the significant additional cost.