News in brief - Aug. 11, 2008

Review doubts value of breast exams - Kidney stones tied to climate change - Accompanied older patients more satisfied with care - Emergency patients unaware of how little they understand instructions

Review doubts value of breast exams

A review of the literature on breast self-exams found no evidence that the self-exams actually reduce breast cancer deaths.

The new review released July 15 by the Cochrane Collaboration, an independent organization that reviews health interventions, found that the practice could do more harm than good by leading to nearly twice as many biopsies that turned up no cancer in women who do the exams compared with women who do not.

Although reviewers do not recommend it, they acknowledged that women may want to continue the exams. They urged women to "seek medical advice if they detect any change ... that might be breast cancer."

Kidney stones tied to climate change

Global warming is likely to increase the proportion of the population affected by kidney stones by expanding the area of the nation most affected by the ailment, said researchers at the University of Texas Southwestern Medical Center and the University of Texas, both in Dallas.

The "kidney stone belt" includes Southeast states and has been attributed, in part, to regional temperature differences. Dehydration is one risk factor linked to kidney stone disease, and the study -- in the July 14 Proceedings of the National Academy of Sciences -- suggests that global warming will exacerbate this effect.

Researchers say that by 2050, higher temperatures will cause 1.6 million to 2.2 million more kidney stone cases, representing up to a 30% growth in some areas.

Accompanied older patients more satisfied with care

People older than 65 are more likely to have a favorable view of doctors if they have a companion with them for appointments, says a study in the July 14 Archives of Internal Medicine.

Researchers analyzed data on a sample of 12,018 Medicare beneficiaries. Approximately 39% brought spouses or adult children to routine medical visits who recorded physician instructions and supplied information about medical conditions. They also asked questions and explained directions. Patients who had companions tended to be older, sicker and less educated but also more likely to be "highly satisfied" with a physician's technical abilities, information sharing and interpersonal skills.

"Our findings suggest that visit companions could be an important resource for vulnerable adults," said Jennifer L. Wolff, PhD, lead author and assistant professor in the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Emergency patients unaware of how little they understand instructions

The majority of patients do not fully comprehend what they are supposed to do after leaving an emergency department even though they think they do, according to a study published online in July in the Annals of Emergency Medicine.

"This study shows that many patients walk away from important clinical encounters confident that they know what happened and why but with little reason to be so confident," said Peter Ubel, MD, one of the authors and a professor of internal medicine at the University of Michigan Medical School in Ann Arbor.

Researchers interviewed 140 patients in emergency care. About 32% did not understand their diagnosis, and 61% could not comprehend their care. Some 73% did not understand what they should do after discharge, and 46% did not grasp that they needed to return to another doctor. Only 20% knew they did not understand.

The authors suggest that instead of asking if patients have any questions, physicians should ask patients to repeat instructions in their own words.

Vote refines AMA stance on health reform
The AMA House of Delegates rejected attempts to rescind support of a U.S. House health reform bill and any new government-sponsored health insurance plan during the 2009 Interim Meeting.
Story - AMA House - Slideshow