Checking donor register increases donations
FAMILIES are more likely to consent to organ donation if the Australian Organ Donor Register (AODR) is checked, irrespective of the outcome of that check, according to research published in the MJA. The researchers collated raw data from 21 Victorian hospitals on nearly 8800 deaths to find 294 cases where discussion on organ donation with relatives was documented. They found that consent was given in 57% of cases. “The AODR was checked in 147 (50%) of the cases involving discussion”, the researchers wrote. “The rate of family member consent for people registered as consenting on the AODR was 93%, compared with 70% for those who were not listed. When the AODR was not checked, the family consent rate was 39%.” They said their findings suggested a clear case for improving public awareness and use of the AODR through promotional activities. “Other than the time and effort required, there appears to be little downside to checking the AODR before discussing organ donation with a family”, they wrote.
CBT reduces hypochondria
MEDICAL patients who received a modified cognitive behaviour for health anxiety therapy (CBT-HA) improved rapidly after treatment according to the results of a multicentre randomised trial published in The Lancet. Of 28 991 patients screened, 444 were randomly assigned to receive either CBT-HA or standard care. The health anxious patients attending cardiac, endocrine, gastroenterological, neurological and respiratory medicine clinics in secondary care were aged from 16 to 75 years. Patients allocated to CBT-HA, who received outpatient treatment by non-experts in CBT, improved rapidly after treatment and showed significantly greater reduction in health anxiety compared with the standard care group. At 1 year, 14% of CBT-HA patients had levels of health anxiety in the normal range compared with 7% in the control patients. Patients in the CBT-HA group also showed significantly greater improvement in self-rated anxiety and depression symptoms at 6 and 12 months. The researchers said many eligible patients had declined to take part in the study. “As many people with hypochondriasis and health anxiety attribute their bodily symptoms unequivocally to medical pathology, and therefore feel that only medical expertise can help them, attitudes, both from staff and patients, need to change before the treatment can be given more widely”, they wrote. “But if change does not occur, and standard medical care fails to be aware of health anxiety, an important, largely hidden, but eminently treatable cause of morbidity in medical clinics is likely to persist.” An accompanying commentary said the findings would be difficult to translate into services, mainly due to the cost.
Big rise in donor eggs for IVF
US research shows the number of oocyte donations for in-vitro fertilisation increased significantly between 2000 and 2010. The research, published in JAMA, used data from 443 fertility clinics and found the annual number of donor oocyte cycles had increased from 10 801 to 18 306 in that period. They also found an increase in good perinatal outcomes from embryo transfers. The age of recipients during the research period remained consistent at 41 years, with the researchers finding age had no significant association with good perinatal outcome. A high percentage of multiple births was also found, with the researchers speculating that this was due to the transfer of multiple embryos on day 5, which “suggests potential for further improvement in perinatal outcomes if elective single-embryo transfer is used more frequently”. The researchers called for more studies to evaluate how race/ethnicity, infertility diagnosis and day of embryo culture affect perinatal outcomes in both autologous and donor IVF pregnancies. An accompanying editorial said although the research provided useful information for infertile couples and doctors, “there is uncertainty about longer-term issues such as effects on the donor’s own fertility or the need to inform recipients about the discovery of health issues not known at the time of donation”.
Psoriasis linked to chronic kidney disease
MODERATE to severe psoriasis is associated with moderate to advanced chronic kidney disease independent of traditional risk factors, according to research published in the BMJ. In the population-based cohort study, 136 529 patients with mild psoriasis and 7354 patients with severe psoriasis based on treatment patterns were matched to 689 702 unaffected patients. The adjusted hazard ratios (95% confidence intervals) for incident chronic kidney disease were 1.05 (1.02 to 1.07), 0.99 (0.97 to 1.02), and 1.93 (1.79 to 2.08) in the overall, mild and severe psoriasis groups, respectively. Age was a significant effect modifier in the severe psoriasis group. The researchers suggested that patients with psoriasis affecting 3% or more of their body should be closely monitored for renal insufficiency, such as routine screening urinalysis for microalbuminuria and serum creatinine and blood urea nitrogen testing. “Increased screening efforts will allow for earlier detection and intervention to reduce the substantial morbidity and mortality associated with chronic kidney disease”, the researchers wrote. They also recommended that the risk versus benefit of potentially nephrotoxic drugs in patients with moderate to severe psoriasis should be carefully considered.
BMI not biggest mortality predictor
A STUDY of more than 15 000 patients who met eligibility criteria for bariatric surgery, published in JAMA Surgery, has found age and type 2 diabetes were the main mortality risks for these patients, but not body mass index (BMI). The researchers found all-cause 10-year mortality for eligible obese patients was 2.1%, with age, type 2 diabetes, male sex, smoking, BMI, coronary artery disease and cardiovascular disease (CVD) significant mortality predictors. However, they found that although their association with the outcome was statistically significant, established CVD and BMI did not contribute materially to the mortality prediction in the primary analysis. “Our results challenge conventional wisdom emphasizing the importance of BMI as a prognostic indicator for mortality in individuals eligible for bariatric surgery”, the researchers wrote. Of the obesity-related comorbidities, type 2 diabetes was the most important mortality predictor. “Given that diabetes mellitus is highly amenable to surgical treatment, a strong case could be made for prioritizing it over BMI or other comorbidities”, they wrote. “Regardless, our findings call into question current practices, such as the inordinate emphasis placed on BMI increments of 5.0 embedded in contemporary eligibility criteria.”
Depression rates high in aged care
A REPORT from the Australian Institute of Health and Welfare shows that more than half of permanent residents in residential aged care are depressed. The report looked at the prevalence of symptoms of depression, based on the Cornell Scale for Depression, in 166 362 aged care residents at 30 June 2012 and 235 036 people admitted to permanent aged care for the first time between March 2008 and August 2012. The report said the 52% prevalence of depression among residents was higher than previously estimated and higher than the estimated 10%-15% of older people with depression living in the community. The report also found that about 45% of newly admitted residents had depression. The report authors said residents with symptoms of depression were more likely than those without to have high care needs. The authors used appraisals data from the Aged Care Funding Instrument (ACFI), used to allocate federal government funding to residential aged care providers. They said the ACFI was a “powerful data source for analysing the care needs of residential aged care clients”. “The analyses here of depression symptoms in residential aged care have resulted in findings that would benefit from more detailed exploration”, they wrote.