Current trends in U.S. cardiology practice

Over the last six years, the practice of cardiology in the U.S. has experienced a substantial transition from independent practice to practices integrated within hospital systems. This change has been driven by major economic factors that have largely been determined by the federal government. Meanwhile, cardiologists? salaries and the demand for new cardiologists have remained stable. Best practices have embraced this new partnership with hospital systems to improve quality, cost, and access to cardiovascular care.     

A Multi-Year Study of Tobacco Control in Newspaper Editorials Using Community Characteristic Data and Content Analysis Findings

We content analyzed 1,473 newspaper editorials for topic, tone, and slant, and connected the results to community characteristic data: clean indoor air ordinance status for cities, and official smoking rates for counties. The analysis occurred during a multi-year project aimed at prompting communities to adopt clean indoor air policies. The results showed that most editorials were about tobacco restrictions or ordinances, were neutral in tone, and provided factual information about tobacco control. More editorials were negatively slanted vs. positively slanted toward tobacco control. Most editorials with positive tones were published in newspapers in towns that already had clean indoor air policies. We concluded that editorials might hold increased weight in spurring change, as the percentage of smokers in a city is unrelated to the town enacting a clean indoor air ordinance.     

Acne Knowledge of Hispanic Parents of Teenagers with Mild to Moderate Acne

We performed a cross‐sectional study of Hispanic and non‐Hispanic parents of children with acne using a survey designed to determine their level of awareness of acne and its treatment; 82% of Hispanic parents and 40% of non‐Hispanic parents agreed that a health care provider should treat mild acne (p < 0.001). Hispanic parents of adolescents with acne agreed more frequently than non‐Hispanic parents that children with mild and moderate acne should be taken to a health care provider for treatment, but they tended not to visit health care providers. Future studies should aim to determine the reasons for this discrepancy, after which culturally sensitive educational programs can be developed to address this disparity.     

Carcinoma of the Breast

A great deal of controversy surrounds the question of the effectiveness of treatment of breast carcinoma, particularly radical surgical procedures in early cases.

The results of simple mastectomy followed by radiotherapy are compared with those of radical surgery in two series of cases, in Edinburgh and at the Mayo Clinic, respectively; despite the many variables involved in such a comparison, the figures are of interest because of their similarity.

Endocrine therapy in metastasizing breast cancer has profoundly altered malignant growth in some cases. Hypophysectomy is gaining favor and appears to be superseding adrenalectomy.     

Diagnosis,staging, and risk stratification in prostate cancer: Utilizing diagnostic tools to avoid unnecessary therapies and side effects

A lack of appropriate diagnostic tools for prostate cancer has led to overdiagnosis and over treatment. In a recent publication in the New England Journal of Medicine, Hamdy et al showed no difference in the outcomes of patients that had undergone either radical prostatectomy, radiotherapy, or active monitoring. In an effort to enhance clinical stratification, the development of improved, more accurate diagnostic tools is actively being pursued. Herein, we explore recent advances in prostate cancer screening, including biomarker assays, genetic testing, and specialized fields, such as mathematical oncology. These newly developed, highly sensitive diagnostic assays may potentially aid clinicians in selecting appropriate therapies for patients in the very near future.     

Travel Distance and Home Dialysis Rates in the United States

♦ Introduction: Rural residence is associated with increased peritoneal dialysis (PD) utilization. The influence of travel distance on rates of home dialysis utilization has not been examined in the United States. The purpose of this study was to determine whether travel distances to the closest home and in-center hemodialysis (IHD) facilities are a barrier to home dialysis.♦ Methods: This was a retrospective cohort study of patients aged ≥ 18 years initiating dialysis between 2005 and 2011. Unadjusted PD and home hemodialysis (HHD) rates were compared by travel distances to both the closest home dialysis and closest IHD facilities. Adjusted PD and HHD utilization rates were examined using multivariable logistic regression models.♦ Results: There were 98,608 patients in the adjusted analyses. 55.5% of the dialysis facilities offered home dialysis. IHD, PD and HHD patients traveled median distances of 5.4, 3.5 and 6.6 miles respectively to their initial dialysis facilities. Unadjusted analyses showed an increase in PD rates and decrease in HHD rates with increased travel distances. Adjusted odds of PD and HHD were 1.6 and 1.2 respectively for a ten mile increase in distance to the closest home dialysis facility, while for distances to the closest IHD facility the odds ratios for both PD and HHD were 0.7 (all p < 0.01).♦ Conclusions: In metropolitan areas, PD and HHD generally increased with increased travel distance to the closest home dialysis facility and decreased with greater distance to an IHD facility. Examination of travel distances to PD and HHD facilities separately may provide further insight on specific barriers to these modalities which can serve as targets for future studies examining expansion of home dialysis utilization.     

Cohort difference in sexual orientation: results from a large age-stratified population sample

BACKGROUND: There is some community survey evidence for a cohort difference in female sexual orientation. OBJECTIVE: To determine whether there is a cohort difference in sexual orientation in Australia. METHODS: A community survey was carried out with a sample of 7,447 adults from the age groups 20-24, 40-44 and 60-64 years. As part of this survey respondents were asked a question on sexual orientation which was answered privately. RESULTS: A strong age cohort difference was found for women, with younger women more frequently reporting a homosexual or bisexual orientation. By contrast, no age cohort difference was found for men. CONCLUSION: These findings suggest that a heterosexual orientation may have become less common in younger cohorts of Australian women. This finding is consistent with data from other recent studies.     

British Association of Stroke Physicians: benchmarking survey of stroke services

BACKGROUND: the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. OBJECTIVE: to describe the organisation and staffing of specialist hospital-based stroke services in the UK. DESIGN: a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. RESULTS: the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. CONCLUSIONS: significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.