Research Round-up

Bones, Breast Cancer and Bucks: A Study on Cost-Effectiveness

Kouta Ito, MD, MS

Kouta Ito, MD, MS, of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine, evaluated the cost-effectiveness of current screening and treatment guidelines for bone loss in postmenopausal women taking aromatase inhibitors for hormone receptor-positive early breast cancer. (Aromatase inhibitors can increase the risk of osteoporosis and related fractures.)

Ito developed a computer simulation model to project the impact of a variety of screening and treatment strategies on costs and quality of life.

Ito and fellow researchers found that annual bone mineral density screening followed by selective oral bisphosphonate therapy for women with osteoporosis was most cost-effective. However, universal bisphosphonate therapy would also become cost-effective if an anti-cancer effect of bisphosphonates is considered. The researchers suggest that future guidelines for bone fracture prevention should address the optimal use of bisphosphonates on the basis of not only their ability to prevent bone loss, but also their potential to improve breast cancer outcomes.

The study was published in the February 28, 2012, online issue of the Journal of Clinical Oncology.

Physiological Networks and the Body's Complex Communications

Plamen Ivanov

The human organism is an integrated network where physiological systems, each with its own regulatory mechanisms, continuously interact, and where failure of one system can trigger a breakdown of the entire network. Despite its importance to physiology and medicine, the network of physiologic interactions remains unknown.

In a first of its kind study, an international group of researchers from BWH, Israel and Germany, led by Plamen Ch. Ivanov, PhD, DSc, associate physiologist, of BWH's Sleep Medicine Division, may be on the path to an answer.

Over several years, the researchers developed a framework to identify dynamic interactions among diverse systems (e.g., cerebral, cardiac, respiratory, ocular and locomotor). Using sleep stages as a model of various physiological states (i.e., light sleep, deep sleep, REM), the researchers quantified a robust network of interactions.

"Each sleep stage is characterized by a specific network structure, demonstrating a clear relation between network topology and physiologic function," said Ronny Bartsch, PhD, BWH researcher and member of the study team.

The findings can impact clinical care. Given that multiple organ failure is a primary reason for death, this network approach may help researchers and clinicians assess whether links between physiological systems remain significantly changed even after the function of specific systems have been restored after treatment.

The study is a first step towards developing a map of communications between organ systems, and may serve as a catalyst for a new field called network physiology.

The study was published in the February 28, 2012, online issue of Nature Communications.

Questioning Quality of Imaging Measure

Ali Raja

Jeremiah Schuur

Emergency Medicine's Jeremiah Schuur, MD, MHS, director of quality and performance improvement in the Department of Emergency Medicine, and Ali Raja, MD, MBA, associate director of Trauma, Department of Emergency Medicine, and colleagues published findings that question the reliability of a new Centers for Medicare and Medicaid Services (CMS) imaging efficiency measure.

CMS developed measure OP-15 to evaluate the emergency department (ED) use of brain CT for atraumatic headache in an attempt to improve imaging efficiency. The measure was implemented into the Outpatient Prospective Payment System in January 2012 but was never field-tested.

The researchers reviewed the CMS administrative data and medical records of 748 patients from 21 EDs in the United States to determine the reliability, validity and accuracy of measure OP-15. All the patients reviewed had been labeled by CMS as having undergone inappropriate brain CTs based on billing data.

However, when the patients' medical records were reviewed, they showed that the bills didn't tell the whole story; the researchers discovered that 65 percent of the CT scans actually complied with Medicare's measure, and another 18 percent of patients had valid reasons for the CTs documented on their charts. Overall, 83 percent of the patients should not have been labeled as having been inappropriately imaged.

This led researchers to conclude that CMS measure OP-15 may lead to inaccurate comparisons of EDs' imaging performance.

The study was electronically published February 23, 2012 in Annals of Emergency Medicine.

Study Finds Masks Prevent Spread of TB

Ed Nardell

In a first of its kind study, BWH researchers found that having tuberculosis patients wear surgical masks cut the likelihood of transmitting the infection in half.

"Although surgical masks have been used on patients with infectious respiratory diseases since the influenza pandemic of 1918, their efficacy has never been demonstrated," said Ed Nardell, MD, of the Division of Global Health Equity and principal investigator of the study. "This study is the first to quantify their effectiveness under conditions similar to real life."

The study included patients with multi-drug resistant TB who were receiving care in South Africa. Typically, care providers and other health care team members wear the masks, rather than the patients.  This study tested how well it worked for patients to wear the masks to prevent TB, which is spread through droplets in the air.

 "Other precautions are needed, but masks are a readily available intervention, now of proven efficacy, even in poor settings," said Nardell. 

The study was published in the American Journal of Respiratory and Critical Care Medicine.

Turn Off Protein, Turn On Lung-Healing 

Researchers from BWH and the University of Melbourne, Royal Melbourne Hospital in Australia, have identified that serum amyloid A plays a key role in chronic inflammation and lung damage in chronic obstructive pulmonary disease (COPD) and also inhibits the natural effort of the lung to repair itself after smoking has stopped. The discovery could lead to the development of a new treatment strategy with lipoxin stable analogs (synthetic forms of a natural healing agent) to boost lung-healing. This new approach could also improve the effectiveness of steroid treatment for COPD, which is effective in treating other lung diseases such as asthma. It is hoped the new treatment will go to clinical trial within the near future.

 The study is published in the Proceedings of National Academy of Science.