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September 10, 2009 Volume VI, No. 17

HIN Communications Editor Laura Greene

Dear Healthcare Intelligence Network Client,

Part of DM today involves lifestyle medicine — an area of medicine that suggests that modifiable behaviors, such as activity, eating and other habits, can contribute greatly to the onset of some disease and, in some cases, more directly to death. In this week's Disease Management Update, new research indicates that lifestyle medicine can help prevent breast cancer, and a leader in the field gives his predictions as to when lifestyle medicine will become part of med school curricula

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Early Lung Cancer Detection
  2. Genetic Marker for Ovarian Cancer
  3. Care Team Roles
  4. Lifestyle Medicine
  5. Healthcare Trends & Studies
  6. Preventing Breast Cancer
  7. Telehealth in 2009

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Early Lung Cancer Detection

Narrow-band imaging bronchoscopy increases the specificity of bronchoscopic early lung cancer detection and can serve as an alternative detection device, according to research published in the September 2009 issue of the Journal of Thoracic Oncology.

To confirm the efficiency of this new technology, researchers conducted a 10-month review of patients in need of airway screening and surveillance. Patients were randomized into groups receiving WFB, AFI or NBI bronchoscopies and any observed abnormal airway mucosa was biopsied.

Out of 57 patients, 30 percent were diagnosed with intraepithelial neoplasia. Researchers found that those observed with NBI and AFI bronchoscopies experienced significantly superior sensitivities compared to WLB alone. NBI also proved to provide high levels of specificity compared to AFI.

"This research shows that when diagnosing early stage lung cancer, using NBI may be a better option than AFI because it increases specificity without compromising sensitivity," said Felix J.F. Herth, M.D. of the department of Pneumology and Critical Care Medicine at the University of Heidelberg in Germany. "Continued research on these detection methods is necessary to further understand the best, most accurate ways to increase early diagnosis in lung cancer."

To learn more about this research, please visit:
http://www.sciencedaily.com/releases/2009/09/090902133641.htm

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Scientists Find Genetic Marker for Ovarian Cancer

A new genetic marker associated with ovarian cancer risk was recently discovered by an international research group led by scientists from the Cancer Research Genetic Epidemiology Unit in the United Kingdom as a part of the Ovarian Cancer Association Consortium, a worldwide forum of scientists performing ovarian cancer research.

The study used a genome-wide association design in which the frequencies of hundreds of thousands of genetic variations across the genome are compared between large numbers of cases and unaffected controls. Overall more than 20,000 women participated in this study.

The new marker was found on chromosome 9, close to the BNC2 (basonuclin 2) gene that encodes a protein that plays a role in regulation of DNA transcription and is highly expressed in reproductive tissues. This marker is present among 32 percent of women and contributes an estimated 0.7 percent to ovarian cancer risk. The association of this marker with risk was stronger for serous carcinoma, the most common (and most lethal) ovarian cancer subtype.

To learn more about this research, please visit:
http://www.hawaii.edu/news/article.php?aId=3071

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Staffing and Roles of the Care Team in the Medical Home

Although Group Health Cooperative's increased their primary care staff, patients are still successful in connecting with their caregivers, says Michael Erikson, vice president of primary care services for Group Health Cooperative. In fact, the key to a patient's understanding of his care team lies in the physician's hands. In this podcast, Erikson discusses the effect Group Health's staff expansion has had on its patients, as well as the many benefits of contacting patients via phone and e-mail in lieu of in-person office visits.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#99

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Incorporating Lifestyle Medicine in Medical School Curricula

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Edward Phillips, M.D., director of outpatient medical services at Spaulding Rehabilitation Hospital Network and assistant professor of the Department of Physical Medicine and Rehabilitation at Harvard Medical School.

Question: How soon do you think that lifestyle medicine will be incorporated into medical school curricula?

Response: We’re working at a foundation level to begin the initial lectures in lifestyle medicine. Some of the rudiments of lifestyle medicine — learning about exercise, stress management and tobacco cessation — are taught more frequently than they were 15 or 20 years ago. The average student entering medical school looks to be at least somewhat more fit. The challenge with the new group coming up through medical school and through training is the likelihood of keeping them fit rather than convincing them to change their personal behaviors. The stress that they undergo getting through their training is considerable. We’ve talked about the continuing medical education (CME) programs at the graduate level toward the older physicians, but we need to go to the graduate level or the actual training of physicians. We’re trying to get in at the ground floor with the medical students. This is going to take many years, but we’re starting out for this.

For more information on persuading physicians to prescribe behavior change and self-efficacy, please visit:
http://store.hin.com/product.asp?itemid=3826

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Tobacco Cessation and Prevention Programs

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Preventing Breast Cancer

The largest review of research into lifestyle and breast cancer ever conducted has confirmed that women can reduce their risk by maintaining a healthy weight, being physically active, drinking less alcohol and breastfeeding their children. The massive American Institute for Cancer Research/World Cancer Research Fund (AICR/WCRF) project looked at the evidence on the links between breast cancer and diet, body weight and physical activity.

“This study represents the clearest picture we have ever had on how lifestyle affects a woman’s risk of breast cancer,” said Martin Wiseman, M.D., medical and scientific adviser for AICR and WCRF. “We are now more certain than ever that by maintaining a healthy weight, being physically active and limiting the amount of alcohol they drink, women can dramatically reduce their risk.”

Because of the link between excess body fat and cancer, AICR recommends aiming to be as lean as possible without becoming underweight. AICR also recommends being physically active for at least 30 minutes every day. If you drink at all, limit consumption to two drinks a day for a man and one for a woman. AICR also recommends that mothers breastfeed exclusively for up to six months and then add other liquids and foods. Evidence is convincing that mothers who breastfeed reduce their risk for breast cancer. There is also probable evidence that children who are breastfed have a lower risk of gaining excess weight as they grow.

“We estimate that almost 40 percent of breast cancer cases in the U.S. &mash; or about 70,000 cases every year &mash; could be prevented by making these straightforward everyday changes,” added Susan Higginbotham, Ph.D., R.D., AICR director of research.

To learn more about this research, please visit:
http://www.aicr.org/site/News2?abbr=pr_&page=NewsArticle&id=16495&news_iv_ctrl=1102

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Telehealth in 2009

While rising healthcare costs fuel much of the healthcare reform debate, many healthcare organizations are turning to telehealth to lower costs and improve efficiencies while expanding patients' access to services. Complete HIN's Survey of the Month on Telehealth in 2009 by September 30 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com

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