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Study: Smartphones and tablets key to getting more clinicians to screen patients for tobacco use

BY Michael Johnsen

NEW YORK — Smartphones and tablets may hold the key to getting more clinicians to screen patients for tobacco use and advise smokers on how to quit. Using mobile phones loaded with tobacco screening guidelines prompted nurses to ask patients about their smoking habits in 84% of clinic visits and to offer cessation counseling to 99% of smokers who expressed a willingness to kick the habit, according to a study from Columbia University School of Nursing published in Oncology Nursing Forum.

“These findings suggest that mobile applications can play a significant role in curbing tobacco use,” stated lead study author Kenrick Cato, associate research scientist at Columbia Nursing. Currently, U.S. patients are screened for tobacco use in about 60% of office visits, and smokers are advised on how to quit less than 20% of the time, according to the Centers for Disease Control and Prevention. “These findings are a win in the ongoing battle against tobacco use, and they also point to a broader benefit of mobile applications in getting more clinicians to follow evidence-based practice guidelines,” Cato said.

The study evaluated tobacco screening rates for more than 14,000 visits at clinics in New York City. Clinic patients were treated by 185 registered nurses enrolled in advanced practice degree programs at Columbia Nursing. 

Funding for the research was provided by the National Institute of Nursing Research and the National Cancer Institute.

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Study: Derivative of vitamin A helps turn pre-cancer cells back to normal healthy breast cells

BY Michael Johnsen

PHILADELPHIA — A derivative of vitamin A, known as retinoic acid, found abundantly in sweet potato and carrots, helps turn pre-cancer cells back to normal healthy breast cells, according to research published this month in the International Journal of Oncology. The research could help explain why some clinical studies have been unable to see a benefit of vitamin A on cancer: the vitamin doesn’t appear to change the course of full-blown cancer, only pre-cancerous cells, and only works at a very narrow dose.

Because cells undergo many changes before they become fully aggressive and metastatic, Sandra Fernandez, assistant research professor of medical oncology at Thomas Jefferson University, and colleagues used a model of breast cancer progression composed of four types of cells, each one representing a different stage of breast cancer: normal, pre-cancerous, cancerous and a fully aggressive model.

When the researchers exposed the four breast cell types to different concentrations of retinoic acid — one of the chemicals that the body converts vitamin A into — they noticed a strong change in the pre-cancerous cells. Not only did the pre-cancerous cells begin to look more like normal cells in terms of their shape, they also changed their genetic signature back to normal. 

“We were able to see this effect of retinoic acid because we were looking at four distinct stages of breast cancer,” Fernandez said. “It will be interesting to see if these results can be applied to patients.”

The cells that were considered fully cancerous did not respond at all to retinoic acid, suggesting that there may be a small window of opportunity for retinoic acid to be helpful in preventing cancer progression. In addition, the researchers showed that only one concentration of retinoic acid (about one micro Molar) produced the anti-cancer effects. Lower concentrations gave no change, and higher concentrations produced a smaller effect.

The next step will be to try to learn whether the amount of retinoic acid required can be maintained in an animal model, and if that concentration will have the same effects as Fernandez observed in cells. If those studies show the same effect, the next step would be to test whether these observations hold true in humans. 

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Study: More doctors testing for vitamin D deficiency as disease prevention tactic

BY Michael Johnsen

WINSTON-SALEM, N.C. — New research from Wake Forest Baptist Medical Center suggests that physicians are ordering vitamin D deficiency screening tests for preventive care purposes rather than after patients develop conditions caused by decreased bone density.

For older patients, having a low vitamin D level is a condition that can cause weakening of bones, which can lead to fractures, and in children the deficiency can lead to rickets. The 2011 Institute of Medicine guidelines for vitamin D and calcium emphasize their importance in skeletal health and increased research findings, along with widespread media reports, have raised awareness about vitamin D deficiency, the researchers reported.

Karen Huang, a research specialist in the Center for Dermatology Research at Wake Forest Baptist Medical Center and lead author of the study, said the rise in vitamin D deficiency awareness among doctors warranted a look at how often doctors were diagnosing this condition during visits.

"From 2007 to 2010, we noted that the number of diagnoses for vitamin D deficiency rapidly increased and tripled from 2008 to 2010," Huang said. "Previously, diagnoses of low vitamin D levels largely may have been used to identify why someone had a fracture or weak bones. In our data, we found that only 10% of visits with low vitamin D mentioned the patient having weak bones or a fracture."

The study is published in the April issue of Southern Medical Journal of the Southern Medical Association. Huang and colleagues used data from the National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys to assess the rate of vitamin D deficiency diagnoses made between 2007 and 2010 during outpatient visits. An estimated 7.5 million visits were linked with the condition at outpatient visits in the United States during this time frame.

At visits where patients were diagnosed with low vitamin D levels, the average patient age was 56.9 and females were 2.6 times more likely to be diagnosed with vitamin D deficiency than males. Individuals 65 years or older were also almost three times more likely to be diagnosed as deficient compared to individuals younger than 65, according to the study.

"We believe this increase in visits with a diagnosis of vitamin D deficiency, but without a diagnosis of weak or fractured bones, suggests that a lot of doctors now are checking patients for this deficiency so that they can help prevent the patients from developing weak bones," Huang said.

 

 

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