Public Release: 

Surgery associated with reduced fractures in patients with hyperparathyroidism

American College of Physicians

1. Surgery associated with reduced fractures in patients with hyperparathyroidism Bisphosphonates shown to increase bone density but did not reduce fractures

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-1232

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Surgery to remove the parathyroid was associated with reduced fracture risk in patients with primary hyperparathyroidism (PHPT), whereas bisphosphonate treatment was associated with increased bone mineral density (BMD) but not fewer fractures. The observational study was published in Annals of Internal Medicine.

PHPT is a common endocrine disorder, affecting approximately 400,000 Americans. Surgery to remove the parathyroid yields prompt and sustained improvements in BMD, but less is known about its effect on fracture risk. Bisphosphonates are a class of drugs commonly prescribed to prevent bone loss in people at risk for fracture. Bisphosphonates improve BMD in patients with PHPT in the short term, but no reductions in fracture risk have been reported with these medications.

Using a large population-based cohort, researchers examined BMD changes and fracture rates among patients with PHPT managed with parathyroidectomy, bisphosphonates, or observation alone. They found that compared with observation only, surgery was associated with fewer hip fractures and fewer fractures of any type. Bisphosphonates were associated with increases in bone mineral density but not with fewer fractures.

The researchers say that although most patients managed in the community who meet guideline criteria do not have surgery, these results suggest that this practice should be reassessed.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Dr. Michael Yeh, please contact Mark Wheeler at MWheeler@mednet.ucla.edu or 310-794-0777.

2. Survival rates way up for adults with acute liver failure

Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2211

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Survival rates for patients with acute liver failure have increased significantly over the past 16 years, according to a study published in Annals of Internal Medicine. The effects of specific changes in intensive care practice may contribute to this improvement.

Acute liver failure is a rare syndrome where liver function decreases severely and rapidly. Principle causes include acetaminophen overdose, ischemic and pregnancy-associated liver injury, and acute infection with hepatitis A or B virus, among others. Outcomes are more favorable for some causes than others, and survival after liver transplantation for patients with acute liver failure is good, but lower than among patients with cirrhosis who receive liver transplant.

The Acute Liver Failure Study Group established a registry in 1998 to better characterize the causes, clinical features, and outcomes of acute liver failure. Researchers sought to update the U.S. experience with acute liver failure at specialized liver transplant centers since the last published overview. Accordingly, they analyzed data on all patients with acute liver failure enrolled between 1998 and 2013, focusing on whether clinical features or outcomes have changed over time. They looked at causes and rates of transplant-free survival and whether utilization of liver transplantation changed in the 16-year observation period.

The researchers found that despite similar causes and severity of acute liver failure, outcomes have improved considerably, with slightly improved survival after liver transplantation and especially with improved survival without transplantation. The authors suggest that more effective intensive care unit management could be a contributing factor.

Note: For an embargoed PDF, please contact Cara Graeff. To speak with the lead author, Dr. William Lee, please contact Cathy Frisinger at cathy.frisinger@utsouthwestern.edu or 214-648-7228.

3. Financial disclosure laws miss nurse interactions with pharmaceutical reps Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2522

Editorial: http://www.annals.org/article.aspx?doi=10.7326/M16-0707

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Financial disclosure laws fail to address nurse interactions with pharmaceutical and medical device industry sales representatives, according to an article published in Annals of Internal Medicine. These interactions may need to be regulated to maintain boundaries between care and sales.

To ensure transparency and inspire public trust, physicians are required by law to disclose personal financial ties to industry. While not able to prescribe medications, nurses still influence patient treatment through physician consultation and patient teaching. Nurses also research, evaluate and select medical products, devices and equipment for hospital purchase. However, these laws fail to address marketing activities targeted at registered nurses, the largest proportion of health professionals.

Researchers interviewed 72 participants with direct experience with industry - staff nurses, administrators, and industry and supply chain professionals - between January 2012 and October 2014 at four acute care hospitals in the metropolitan area of a large western U.S. city and at the annual conference of the American Association of Critical Care Nurses. The study included observations (shadowing and attendance at meetings and sponsored events), in-depth individual interviews, four focus groups, and content analysis of marketing materials and hospital policies.

The researchers found that all 56 nurses in the study interacted with industry in the past year, on average 13 times. One-on-one meetings with sales representatives were the most common interaction, along with sponsored lunches, dinners or events; gift offers; product samples; and paid participation in market research, speakers' bureaus or consulting. Most interactions were with the medical device industry, followed by the pharmaceutical, health technology and infant formula industries. Of the 56 nurses, 33 acknowledged benefits of working with representatives, and more than a quarter said it would be impossible to do their jobs without industry resources.

The research showed that nurses' external financial relationships with industry were very similar to those reported by prescribers, but the most significant interactions occurred in daily practice, such as patient care and continuing education. The current policy environment makes these interactions "invisible," leaving nurses with little guidance to ensure the boundary between service and sales stayed intact. The authors suggest changes in policy and profession to address this issue.

Note: For an embargoed PDF, please contact Cara Graeff. To interview the lead author, Quinn Grundy, RN, PhD, please contact Scott Maier at scott.maier@ucsf.edu or 415-502-6397.

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Review

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Severe Meningoencephalitis in a Case of Ebola Virus Disease

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