Literature Review

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

Background: Research has shown that frail hospital patients are at increased risk of readmission and death. Although several frailty assessment tools have been developed, few studies have examined the application of such tools to predict post-discharge outcomes of hospitalized patients.

Study design: Prospective cohort study.

Setting: General medical wards in Edmonton, Canada.

Synopsis: Researchers enrolled 495 adult patients from general medicine wards in two teaching hospitals. Long-term care residents and patients with limited life expectancy were excluded. Each patient was assessed using three different frailty assessment tools: the Clinical Frailty Scale (CFS), the Fried score, and the Timed Up and Go Test (TUGT). The primary outcomes were 30-day readmission and all-cause mortality. Outcomes were assessed by research personnel blinded to frailty status.

Overall, 211 (43%) patients were classified as frail by at least one tool. In general, frail patients were older, had more comorbidities, and had more frequent hospitalizations than non-frail patients. Agreement among the tools was poor, and only 49 patients met frailty criteria by all three definitions. The CFS was the only tool found to be an independent predictor of adverse 30-day outcomes (23% versus 14% for not frail, P=0.005; adjusted odds ratio, 2.02; 95% CI, 1.19–3.41).

Bottom line: As an independent predictor of adverse post-discharge outcomes, the CFS is a useful tool in both research and clinical settings. The CFS requires little time and no special equipment to administer.

Citation: Belga S, Majumdar SR, Kahlon S, et al. Comparing three different measures of frailty in medical inpatients: multicenter prospective cohort study examining 30-day risk of readmission or death. J Hosp Med. 2016;11(8):556-562.

Short Take

National Program Reduces CAUTI

A national prevention program aimed at reducing catheter-associated urinary tract infections (CAUTIs) has been shown to reduce both catheter use and rates of CAUTI in non-ICU patients.

Citation: Saint S, Greene MT, Krein SL, et al. A program to prevent catheter-associated urinary tract infection in acute care. N Engl J Med. 2016;374(22):2111-2119.

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: The Centers for Medicare & Medicaid Services (CMS) tracks 30-day all-cause readmission rates as a quality measure. Prior studies have looked at various hospital factors associated with lower readmission rates but have not looked at hospitalist staffing levels, level of physician integration with the hospital, and the adoption of a medical home model.

Study design: Retrospective cohort study.

Setting: Private hospitals.

Synopsis: Using the American Hospital Association Annual Survey of Hospitals, CMS Hospital Compare, and Area Health Resources File of private hospitals with no missing data, the study reviewed data from 1,756 hospitals and found the median 30-day all-cause readmission rate to be 16%, with the middle 50% of hospitals’ readmission rate between 15.2% and 16.5%. All hospitals used hospitalists to provide care. Fifty-one percent of hospitals reported fully integrated, or employed, physicians. Twenty-nine percent reported establishment of a medical home.

The study found that higher hospitalist staffing levels were associated with significantly lower readmission rates. Fully integrated hospitals had a lower readmission rate than not fully integrated (15.86% versus 15.93%). Also, physician-owned hospitals had a lower readmission rate than non-physician-owned hospitals, and hospitals that had adopted a medical home model had significantly lower readmission rates. Readmission rates were significantly higher for major teaching hospitals (16.9% versus 15.76% minor teaching versus 15.83% nonteaching).

Bottom line: High hospitalist staffing levels, full integration of the hospitalists, and physician-owned hospitals were associated with lower 30-day all-cause readmission rates for private hospitals.

Citation: Al-Amin M. Hospital characteristics and 30-day all-cause readmission rates [published online ahead of print May 17, 2016]. J Hosp Med. doi:10.1002/jhm.2606

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.

Background: Treating infective endocarditis with four to six weeks of intravenous antibiotics carries a high cost. There are data to support oral antibiotics for right-sided endocarditis due to methicillin-sensitive Staphylococcus aureus (with ciprofloxacin and rifampicin), but experience in using oral antibiotics for infective endocarditis is limited.

Study design: Cohort study.

Setting: Large academic hospital in France.

Synopsis: The researchers included 426 patients with definitive or probable endocarditis by Duke criteria. After an initial period of treatment with intravenous (IV) antibiotics, 50% of the identified group was transitioned to oral antibiotics (amoxicillin alone in 50% and combinations of fluoroquinolones, rifampicin, amoxicillin, and clindamycin in the others).

The risk of death was not increased in the group treated with oral antibiotics when adjusted for the four biggest predictors of death (age >65, type 1 diabetes mellitus, disinsertion of prosthetic valve, and endocarditis due to S. aureus). Nine patients treated with IV antibiotics experienced relapsed endocarditis compared to two patients treated with oral antibiotics.

Patients selected for treatment with oral antibiotics were less likely to have severe disease, significant comorbidities, or infection with S. aureus. The length of treatment with IV antibiotics before switching to oral antibiotics varied widely.

Bottom line: It’s possible low-risk patients with infective endocarditis may be treated with oral antibiotics, but more data are needed.

Citation: Mzabi A, Kernéis S, Richaud C, Podglajen I, Fernandez-Gerlinger MP, Mainardi, JL. Switch to oral antibiotics in the treatment of infective endocarditis is not associated with increased risk of mortality in non-severely ill patients [published online ahead of print April 16, 2016]. Clin Microbiol Infect. doi:10.1016/j.cmi.2016.04.003.

Researchers examined 1567 patient medical records from the Vanderbilt University Medical Center Adult EMU and found a 5.2% prevalence rate of coexisting epilepsy/psychogenic nonepileptic spells (PNES). Other findings include:

·         Epileptic seizures were preceded by a PNES event in 94.4% of epilepsy/PNES patients

·         Patients with epilepsy/PNES had a higher presence of epilepsy risk factors

·         Abnormal brain MRI and abnormal neurological examination were more common in the epilepsy/PNES group. 

Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: the effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62-65.

Researchers examined 1567 patient medical records from the Vanderbilt University Medical Center Adult EMU and found a 5.2% prevalence rate of coexisting epilepsy/psychogenic nonepileptic spells (PNES). Other findings include:

·         Epileptic seizures were preceded by a PNES event in 94.4% of epilepsy/PNES patients

·         Patients with epilepsy/PNES had a higher presence of epilepsy risk factors

·         Abnormal brain MRI and abnormal neurological examination were more common in the epilepsy/PNES group. 

Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: the effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62-65.

Researchers examined 1567 patient medical records from the Vanderbilt University Medical Center Adult EMU and found a 5.2% prevalence rate of coexisting epilepsy/psychogenic nonepileptic spells (PNES). Other findings include:

·         Epileptic seizures were preceded by a PNES event in 94.4% of epilepsy/PNES patients

·         Patients with epilepsy/PNES had a higher presence of epilepsy risk factors

·         Abnormal brain MRI and abnormal neurological examination were more common in the epilepsy/PNES group. 

Chen-Block S, Abou-Khalil BW, Arain A, et al. Video-EEG results and clinical characteristics in patients with psychogenic nonepileptic spells: the effect of a coexistent epilepsy. Epilepsy Behav. 2016;62:62-65.

People with epilepsy are at an increased risk of specific safety-related adverse events while in the hospital. Researchers found that hospitalized patients with epilepsy were at a greater risk for fall with hip fracture, respiratory failure, sepsis, and preventable postoperative death. The authors also reported that adverse events were associated with a prolonged length of stay, as well as an increase in the odds of inpatient death and an increase in high-level post-acute care.

Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy [published online ahead of print June 28, 2016]. Epilepsia. 2016;doi:10.1111/epi.13440.

People with epilepsy are at an increased risk of specific safety-related adverse events while in the hospital. Researchers found that hospitalized patients with epilepsy were at a greater risk for fall with hip fracture, respiratory failure, sepsis, and preventable postoperative death. The authors also reported that adverse events were associated with a prolonged length of stay, as well as an increase in the odds of inpatient death and an increase in high-level post-acute care.

Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy [published online ahead of print June 28, 2016]. Epilepsia. 2016;doi:10.1111/epi.13440.

People with epilepsy are at an increased risk of specific safety-related adverse events while in the hospital. Researchers found that hospitalized patients with epilepsy were at a greater risk for fall with hip fracture, respiratory failure, sepsis, and preventable postoperative death. The authors also reported that adverse events were associated with a prolonged length of stay, as well as an increase in the odds of inpatient death and an increase in high-level post-acute care.

Mendizabal A, Thibault DP, Willis AW. Patient safety events in hospital care of individuals with epilepsy [published online ahead of print June 28, 2016]. Epilepsia. 2016;doi:10.1111/epi.13440.

In a study of 1816 patients with tuberous sclerosis complex (TSC), researchers found that specific disease manifestations—cardiac rhabodmyomas, retinal hemartomas, renal cysts, renal angiomyolipipomas, and facial angiofibromas—were associated with a higher likelihood of epilepsy development. The authors posit that this research can help identify patients who will benefit from novel, targeted, preventative treatments.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex [published online ahead of print July 15, 2016]. Epilepsia. 2016;doi:10.1111/epi.13467. 

In a study of 1816 patients with tuberous sclerosis complex (TSC), researchers found that specific disease manifestations—cardiac rhabodmyomas, retinal hemartomas, renal cysts, renal angiomyolipipomas, and facial angiofibromas—were associated with a higher likelihood of epilepsy development. The authors posit that this research can help identify patients who will benefit from novel, targeted, preventative treatments.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex [published online ahead of print July 15, 2016]. Epilepsia. 2016;doi:10.1111/epi.13467. 

In a study of 1816 patients with tuberous sclerosis complex (TSC), researchers found that specific disease manifestations—cardiac rhabodmyomas, retinal hemartomas, renal cysts, renal angiomyolipipomas, and facial angiofibromas—were associated with a higher likelihood of epilepsy development. The authors posit that this research can help identify patients who will benefit from novel, targeted, preventative treatments.

Jeong A, Wong M. Systemic disease manifestations associated with epilepsy in tuberous sclerosis complex [published online ahead of print July 15, 2016]. Epilepsia. 2016;doi:10.1111/epi.13467. 

To determine if patients with epilepsy are appropriate candidates for resective surgery, presurgical conferences are conducted to review magnetic resonance images (MRIs) of the patient’s head. Kenney and associates analyzed repeat reviews of MRIs at presurgical epilepsy conferences to assess their impact on the decision-making process. Among the 233 patients whose charts were re-reviewed, 94 patients (40.3%) had the resective surgery performed, and the analysis revealed that 41 patients (17.6%) had previously undiagnosed findings; 18 of the 41 patients had the surgery. However, among 4 of the 41 patients (9.8%), the re-reviews found abnormalities that did not warrant surgical resection, including autoimmunity and bilateral pathology.  

Kenney DL, Kelly-Williams KM, Krecke KN et al. Usefulness of Repeat Review of Head Magnetic Resonance Images During Presurgical Epilepsy Conferences. Epilepsy Res. 2016. In press.  http://dx.doi.org/10.1016/j.eplepsyres.2016.06.005.

To determine if patients with epilepsy are appropriate candidates for resective surgery, presurgical conferences are conducted to review magnetic resonance images (MRIs) of the patient’s head. Kenney and associates analyzed repeat reviews of MRIs at presurgical epilepsy conferences to assess their impact on the decision-making process. Among the 233 patients whose charts were re-reviewed, 94 patients (40.3%) had the resective surgery performed, and the analysis revealed that 41 patients (17.6%) had previously undiagnosed findings; 18 of the 41 patients had the surgery. However, among 4 of the 41 patients (9.8%), the re-reviews found abnormalities that did not warrant surgical resection, including autoimmunity and bilateral pathology.  

Kenney DL, Kelly-Williams KM, Krecke KN et al. Usefulness of Repeat Review of Head Magnetic Resonance Images During Presurgical Epilepsy Conferences. Epilepsy Res. 2016. In press.  http://dx.doi.org/10.1016/j.eplepsyres.2016.06.005.

To determine if patients with epilepsy are appropriate candidates for resective surgery, presurgical conferences are conducted to review magnetic resonance images (MRIs) of the patient’s head. Kenney and associates analyzed repeat reviews of MRIs at presurgical epilepsy conferences to assess their impact on the decision-making process. Among the 233 patients whose charts were re-reviewed, 94 patients (40.3%) had the resective surgery performed, and the analysis revealed that 41 patients (17.6%) had previously undiagnosed findings; 18 of the 41 patients had the surgery. However, among 4 of the 41 patients (9.8%), the re-reviews found abnormalities that did not warrant surgical resection, including autoimmunity and bilateral pathology.  

Kenney DL, Kelly-Williams KM, Krecke KN et al. Usefulness of Repeat Review of Head Magnetic Resonance Images During Presurgical Epilepsy Conferences. Epilepsy Res. 2016. In press.  http://dx.doi.org/10.1016/j.eplepsyres.2016.06.005.

Before surgeons perform a resection involving the language-dominant hemisphere of a patient with epilepsy, they may do electrical stimulation mapping to identify a patient’s language-dominant hemisphere. Typically they will ask patients to identify objects to help locate the language cortex and then avoid resection in an area of the brain in which electrical stimulation makes it difficult for patients to name said objects. But because word production involves mechanisms that may be centered in more than one area of the brain, Hamberger et al tested locations that have been identified by stimulation as naming sites to look for disparities. Testing patients with refractory temporal lobe epilepsy who had subdural electrodes implanted, they discovered that stimulating naming sites in the superior temporary lobe was more likely to disrupt phonological processing but did not affect a patient’s ability to process semantic information. Stimulating the inferior temporal naming sites was more likely to impair semantic processing. 

Hamberger MJ, Miozzo M, Schevon CA, et al. Functional differences among stimulation-identified cortical naming sites in the temporal region. Epilepsy Behav. 2016;60:124-129. 

Before surgeons perform a resection involving the language-dominant hemisphere of a patient with epilepsy, they may do electrical stimulation mapping to identify a patient’s language-dominant hemisphere. Typically they will ask patients to identify objects to help locate the language cortex and then avoid resection in an area of the brain in which electrical stimulation makes it difficult for patients to name said objects. But because word production involves mechanisms that may be centered in more than one area of the brain, Hamberger et al tested locations that have been identified by stimulation as naming sites to look for disparities. Testing patients with refractory temporal lobe epilepsy who had subdural electrodes implanted, they discovered that stimulating naming sites in the superior temporary lobe was more likely to disrupt phonological processing but did not affect a patient’s ability to process semantic information. Stimulating the inferior temporal naming sites was more likely to impair semantic processing. 

Hamberger MJ, Miozzo M, Schevon CA, et al. Functional differences among stimulation-identified cortical naming sites in the temporal region. Epilepsy Behav. 2016;60:124-129. 

Before surgeons perform a resection involving the language-dominant hemisphere of a patient with epilepsy, they may do electrical stimulation mapping to identify a patient’s language-dominant hemisphere. Typically they will ask patients to identify objects to help locate the language cortex and then avoid resection in an area of the brain in which electrical stimulation makes it difficult for patients to name said objects. But because word production involves mechanisms that may be centered in more than one area of the brain, Hamberger et al tested locations that have been identified by stimulation as naming sites to look for disparities. Testing patients with refractory temporal lobe epilepsy who had subdural electrodes implanted, they discovered that stimulating naming sites in the superior temporary lobe was more likely to disrupt phonological processing but did not affect a patient’s ability to process semantic information. Stimulating the inferior temporal naming sites was more likely to impair semantic processing. 

Hamberger MJ, Miozzo M, Schevon CA, et al. Functional differences among stimulation-identified cortical naming sites in the temporal region. Epilepsy Behav. 2016;60:124-129. 

Open surgical resection is still considered the best approach for patients with epilepsy that do not respond well to medical therapy. But despite being considered the gold standard in neurosurgical care, the shortcomings of open surgical resection need to be addressed. McGovern and colleagues do so in a review published in Current Neurology and Neuroscience Reports. They point to the value of stereotactic electroencephalography, which can localize deep epileptic foci. Similarly laser interstitial thermal therapy (LITT) and stereotactic radiosurgery have advantages because they can ablate specific regions of the brain using minimally or non-invasive techniques. In the case of LITT, it can offer clinicians near real-time feedback on its effects. Neurostimulation is also worth consideration in select patients because it can reduce seizure occurrence without the need for ablation or resection

McGovern RA, Banks GP, McKhann GM 2nd. New techniques and progress in epilepsy surgery. Curr Neurol Neurosci Rep. 2016;16(7):65. 

Open surgical resection is still considered the best approach for patients with epilepsy that do not respond well to medical therapy. But despite being considered the gold standard in neurosurgical care, the shortcomings of open surgical resection need to be addressed. McGovern and colleagues do so in a review published in Current Neurology and Neuroscience Reports. They point to the value of stereotactic electroencephalography, which can localize deep epileptic foci. Similarly laser interstitial thermal therapy (LITT) and stereotactic radiosurgery have advantages because they can ablate specific regions of the brain using minimally or non-invasive techniques. In the case of LITT, it can offer clinicians near real-time feedback on its effects. Neurostimulation is also worth consideration in select patients because it can reduce seizure occurrence without the need for ablation or resection

McGovern RA, Banks GP, McKhann GM 2nd. New techniques and progress in epilepsy surgery. Curr Neurol Neurosci Rep. 2016;16(7):65. 

Open surgical resection is still considered the best approach for patients with epilepsy that do not respond well to medical therapy. But despite being considered the gold standard in neurosurgical care, the shortcomings of open surgical resection need to be addressed. McGovern and colleagues do so in a review published in Current Neurology and Neuroscience Reports. They point to the value of stereotactic electroencephalography, which can localize deep epileptic foci. Similarly laser interstitial thermal therapy (LITT) and stereotactic radiosurgery have advantages because they can ablate specific regions of the brain using minimally or non-invasive techniques. In the case of LITT, it can offer clinicians near real-time feedback on its effects. Neurostimulation is also worth consideration in select patients because it can reduce seizure occurrence without the need for ablation or resection

McGovern RA, Banks GP, McKhann GM 2nd. New techniques and progress in epilepsy surgery. Curr Neurol Neurosci Rep. 2016;16(7):65. 

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson

The incidence of parkinsonism and Parkinson’s disease in a Minnesota county may have increased over a 30-year period, primarily in men age 70 or older, according to a study published online ahead of print June 20 in JAMA Neurology. The increased incidence may be due to changes in smoking behavior during that time or other factors, the researchers said. The trend needs to be confirmed in other populations, they added.

“The decline in smoking rates in men may explain in part the increasing incidence of parkinsonism and Parkinson’s disease. However, other environmental or lifestyle risk or protective factors that are related to sex may also be involved such as pesticide use, head trauma, and coffee consumption,” Walter A. Rocca, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, and coauthors said.

Previous studies have found that smoking is associated with reduced risk of Parkinson’s disease, but whether the relationship is causal remains uncertain. Morozova et al suggested that smokers have a 74% reduction in risk of Parkinson’s disease, possibly attributable to nicotine or other tobacco elements. Researchers have speculated that a decline in smoking frequency after its peak in the 1940s and 1950s may have caused an increase in Parkinson’s disease.

To study this question, Dr. Rocca and coauthors investigated time trends and birth cohort trends for the incidence of parkinsonism and Parkinson’s disease in Olmsted County, Minnesota, from 1976 to 2005.

Parkinson’s Disease and Parkinsonism Definitions

The researchers used medical records from the Rochester Epidemiology Project to identify the frequency of Parkinson’s disease and other types of parkinsonism in Olmsted County during the 30-year period. A movement disorder specialist classified all the medical records based on diagnostic criteria. The researchers defined parkinsonism as the presence of at least two of four cardinal signs (ie, rest tremor, bradykinesia, rigidity, and impaired postural reflexes). They defined Parkinson’s disease as parkinsonism with no other cause, no documentation of unresponsiveness to levodopa at doses of at least 1 g per day in combination with carbidopa, and no prominent or early signs of extensive nervous system involvement.

Researchers analyzed 906 incident cases of parkinsonism with onset between January 1, 1976, and December 31, 2005. The median age of onset was 74, and 501 of the patients with parkinsonism were men. Of the 464 patients with Parkinson’s disease, the median age at onset was 73, and 275 of the patients were men. The investigators evaluated changes in incidence rates for men and for women using two age classes: patients younger than 70 and patients age 70 and older. The investigators used negative binomial regression models to evaluate time trends.

Men and Higher Incident Rates

Overall, men had higher rates of parkinsonism and Parkinson’s disease than women. The incidence rate of parkinsonism in men increased from 38.8 cases per 100,000 person-years between 1976 and 1985 to 56.0 cases per 100,000 person-years between 1996 and 2005. The incidence rate of Parkinson’s disease in men increased from 18.2 cases per 100,000 person-years between 1976 and 1985 to 30.4 cases per 100,000 person-years between 1996 and 2005. Compared with that in men younger than 70, the increase in incidence rates was greater for men age 70 or older. There was not a statistically significant increase in incidence rates of parkinsonism or Parkinson’s disease in women, although there was a nonsignificant increase in the incidence rate of Parkinson’s disease in women age 70 or older.

In addition to lifestyle and environmental factors, increased awareness of symptoms, improved access to care, and better recognition of parkinsonism by physicians also could be responsible for the increased incidence observed, the researchers noted.

Limitations of this study include its small population size. In addition, there were no data on potential risk factors for Parkinson’s disease. As a result, researchers were unable to confirm whether decreased smoking or environmental factors were responsible for the increased incidence rates, according to Honglei Chen, MD, PhD, Head of the Aging and Neuroepidemiology Group at NIH, in an accompanying editorial.

—Erica Robinson