Risk disclosure before treatment important

A study published in PLoS Medicine showed that some doctors, particularly surgeons, are not explaining the risk of specific outcomes that matter most to patients.

Overlooked risks that led to a legal claim or complaint included chronic pain, sexual dysfunction, visual or hearing loss, and the need for re-operation.

Lead author Dr Marie Bismark said the study revealed that doctors may routinely underestimate the importance patients place on understanding certain risks in advance of treatment.

“Increasingly, doctors are expected to advise and empower patients to make rational choices by sharing information that may affect treatment decisions, including risks of adverse outcomes,” she said.

“However, doctors, especially surgeons, are often unsure which clinical risks they should disclose and discuss with patients before treatment and this is reflected in this study.”

The authors found that the most common justifications doctors gave for not telling patients about particular risks before treatment were that they considered such risks too rare to warrant discussion, or that the specific risk was covered by a more general risk that was discussed.

“It is not necessary, or helpful, for doctors to provide a laundry list of all possible risks. Instead, doctors should focus on discussing those risks which are likely to matter most to the patient before them,” she said.

From a sample of nearly 10,000 patient complaints and malpractice claims from Australia between 2001 and 2008, researchers identified 481 disputes involving alleged deficiencies in obtaining informed consent.

The authors found that 45 (9 p.c.) of the cases studied were disputed duty cases - that is, they involved head-to-head disagreements over whether a particular risk ought to have been disclosed before treatment.

Two-thirds of these cases involved surgical procedures, and the majority of them related to five specific outcomes that had quality of life implications for patients, including chronic pain and the need for re-operation.

Most of the other 436 claims and complaints studied involved factual disagreements between doctors and patients – arguments over who said what, and when.

“The best way to avoid this type of ‘he said/she said’ dispute is by keeping a clear record of the consent discussion that take place before any surgical procedure,“ Dr Bismark said.

- MNT

Early childhood:

Listening crucial for success later in life

Young children who pay attention and persist with a task have a 50 percent greater chance of completing college, according to a new study at Oregon State University.

Tracking a group of 430 preschool-age children, the study gives compelling evidence that social and behavioural skills, such as paying attention, following directions and completing a task may be even more crucial than academic abilities. And the good news for parents and educators, the researchers said, is that attention and persistence skills are malleable and can be taught.

“There is a big push now to teach children early academic skills at the preschool level,” said Megan McClelland, an OSU early child development researcher and lead author of the study. “Our study shows that the biggest predictor of college completion wasn't math or reading skills, but whether or not they were able to pay attention and finish tasks at age four.”

Parents of preschool children were asked to rate their children on items such as “plays with a single toy for long periods of time” or “child gives up easily when difficulties are encountered.” Reading and maths skills were assessed at age seven using standardised assessments. At age 21, the same group was tested again for reading and math skills.

Surprisingly, achievement in reading and math did not significantly predict whether or not the students completed college.

McClelland, who is a nationally-recognised expert in child development, said college completion has been shown in numerous studies to lead to higher wages and better job stability. She said the earlier that educators and parents can intervene, the more likely a child can succeed academically.

“We didn't look at how well they did in college or at grade point average,” McClelland said. “The important factor was being able to focus and persist. Someone can be brilliant, but that doesn't necessarily mean they can focus when they need to and finish a task or job.” In a past study, McClelland found that simple, active classroom games such as Simon Says and Red Light/Green Light have been effective tools for increasing both literacy and self-regulation skills.

“Academic ability carries you a long way, but these other skills are also important,” McClelland said.

“Increasingly, we see that the ability to listen, pay attention, and complete important tasks is crucial for success later in life.”

- Todaytopics.com

Gene defects, cause for startle disease

Two studies published in the Journal of Biological Chemistry identify genetic mutations that play important roles in the condition commonly referred to as startle disease. Startle disease is characterised by an exaggerated response to noise and touch, which can interfere with breathing, cause catastrophic falls and even result in death.

The newly identified genetic mutations affect how the signaling molecule glycine, which is responsible for sending messages between nerve cells, is both moved around and used in these cells.

Startle disease, or hyperekplexia, emerges after birth, and while the symptoms usually diminish they sometimes continue into adulthood. The abnormal startle response is caused by glitches in glycine signalling.

Glycine is a small amino acid with various roles in the cell, one of which is to transmit inhibitory signals between nerve cells. In startle disease, defective proteins prevent cells from receiving the inhibitory signals that normally control a person's response to noise and touch. The result is the amplified, harmful response. Startle disease is caused by mutations in multiple genes that encode proteins involved in glycine signalling. For example, one well-known cause is mutation of the glycine receptor alpha1 subunit gene.

But many cases do not involve that gene or the handful of others that have been given close scrutiny, according to Robert Harvey, one of the JBC authors. Working together with Mark Rees, another prominent cause of startle disease was discovered - mutations in the gene for a glycine transporter known as GlyT2.

Rees’ group performed genetic analyses of 93 patients across the globe and identified 19 new recessive mutations in GlyT2. Experiments using molecular models and cell lines in Harvey's group showed that these mutations resulted either in the loss or reduction of glycine uptake by GlyT2.

“Our study represents the largest multicentre screening study for GlyT2 mutations in hyperekplexia to date,” the authors wrote in their paper.

They went on to say the work triples the number of known cases with these mutations, “firmly establishing mutations in the GlyT2 gene as a second major cause of startle disease.”

- isaude.net

Nutrition of young children linked to IQ in later years

Children fed healthy diets in early age may have a slightly higher IQ, while those on heavier junk food diets may have a slightly reduced IQ, according to new research from the University of Adelaide.

The study - led by University of Adelaide Public Health researcher Dr Lisa Smithers - looked at the link between the eating habits of children at six months, 15 months and two years, and their IQ at eight years of age. The study of more than 7,000 children compared a range of dietary patterns, including traditional and contemporary home-prepared food, ready-prepared baby foods, breastfeeding, and ‘discretionary’ or junk foods. “Diet supplies the nutrients needed for the development of brain tissues in the first two years of life, and the aim of this study was to look at what impact diet would have on children's IQs,” Dr Smithers said.

“We found that children who were breastfed at six months and had a healthy diet regularly including foods such as legumes, cheese, fruit and vegetables at 15 and 24 months, had an IQ up to two points higher by age eight.“Those children who had a diet regularly involving biscuits, chocolate, sweets, soft drinks and chips in the first two years of life had IQs up to two points lower by age eight.

“We also found some negative impact on IQ from ready-prepared baby foods given at six months, but some positive associations when given at 24 months,” Dr Smithers said. Dr Smithers said this study reinforces the need to provide children with healthy foods at a crucial, formative time in their lives.

“While the differences in IQ are not huge, this study provides some of the strongest evidence to date that dietary patterns from six to 24 months have a small but significant effect on IQ at eight years of age,” Dr Smithers said.

“It is important that we consider the longer-term impact of the foods we feed our children,” she said.

- ewallstreeter

Healthy food choices improve with colour-coded system

A program designed to encourage more healthful food choices through simple colour-coded labels and the positioning of items in display cases was equally successful across all categories of employees at a large hospital cafeteria. In an article a team of researchers report that the interventions worked equally well across all racial and ethnic groups and educational levels.

“These findings are important because obesity is much more common among Americans who are black or Latino and among those of low socioeconomic status,” said Douglas Levy, lead author of the AJPM report. “Improving food choices in these groups may help reduce their obesity levels and improve population health.”

The authors note that current efforts to encourage healthful food choices by labeling or posting the calorie content of foods have had uncertain results. Even individuals with relatively high educational levels may have difficulty reading and understanding nutritional labels, and the problem is probably greater among low-income or minority individuals with limited literacy.

As reported earlier this year, the MGH research team – which includes leaders of the MGH Nutrition and Food Service - devised a two-phase plan to encourage more healthful food purchases without the need for complex food labels.

In the first phase, which began in March 2010, colour-coded labels were attached to all items in the main hospital cafeteria - green signifying the healthiest items, such as fruits, vegetables and lean meats; yellow indicating less healthy items, and red for those with little or no nutritional value.

The second “choice architecture” phase, which began in June 2010, focused on popular items -cold beverages, pre-made sandwiches and chips - likely to be purchased by customers with little time to spend who may be more influenced by location and convenience.

Cafeteria beverage refrigerators were arranged to place water, diet beverages and low-fat dairy products at eye level, while beverages with a red or yellow label were placed below eye level.

Refrigerators and racks containing sandwiches or chips were similarly arranged and additional baskets of bottled water were placed near stations where hot food was served.

The study was designed to measure changes in employee purchases of green-yellow- and red-labeled items by racial/ethnic categories and by job type during both phases of the program. Data reflecting purchases by more than 4,600 employees, each of whom was enrolled in a program allowing them to pay for meals through payroll deduction, was recorded by cafeteria cash registers and matched to human resources information.

While it was possible to track how an individual employee's food choices changed during the study period, no information that could identify an employee was available to the research team. Participants were categorised by self-reported race or ethnicity - white, black, Latino or Asian. The educational level was reflected by job type - service workers; administrative/support staff; technicians, including radiology technicians and respiratory therapists; health professionals, such as pharmacists and occupational therapists; or management/clinicians, which included physicians and nurses.

At the outset of the study, black and Latino employees and those in job categories associated with lower education purchased more red items and fewer green items than did white employees or those in higher-education job types.

But at the end of both phases of the intervention, employees in all groups purchased fewer red items and more green items.

A specific analysis of beverage purchases - chosen because the consumption of sugar-sweetened beverage is the highest among black and low-income individuals and strongly linked to obesity, diabetes and heart disease - found that the purchase of healthful beverages increased for all groups.

- MNT