"(Patients) think about their out-of-pocket costs and tough decisions like whether to forgo heat, food, and rent, whether to
spend down all of their savings, or whether they can leave a legacy to their children."
Last month, Dartmouth Institute Associate Professor Louise Davies toured the Fukushima Daiichi nuclear power plant, site of the 2011 nuclear accident. Davies is a member of an international task force organized through the International Agency for Research on Cancer, a branch of the World Health Organization. The task force, whose work is being sponsored by Japan's Ministry of Environment, will make recommendations on the monitoring of the thyroid gland after nuclear accidents. As Davies described it an e-postcard to friends and colleagues, the group visiting Fukushima was an "intergenerational group of 20, comprised of people who know and understand the Chernobyl accident thyroid cancer history, and those of us who are the newbies, the next generation." Davis also described the visit as highly organized and heavily focused on reassurance: "The main message I heard was, 'We are managing this, it is all under control, we have a plan.' But 'the plan' is nearly overwhelming in scope and complexity. It extends out decades, with many steps still to be defined, and many parts require constant maintenance and vigilance to make sure there is no malfunction," she wrote.
An interdisciplinary team from The Dartmouth Institute (Nancy Morden, MD and Chiang-Hua Chang PhD), Dartmouth-Hitchcock (David Malenka, MD, cardiology), and the Department of Neurosurgery, Thomas Jefferson University Hospital (Kimon Bekelis, MD) recently published the results of a study investigating hemorrhage associated with direct oral anticoagulants (DOACs) and antiplatelet combination therapy in elderly coronary artery stent recipients. Since their introduction into the market in 2010, DOACs have grown in popularity, and their use has seen rapid growth in atrial fibrillation (AF) patients, and in patients with acute coronary syndromes (ACS). In patients with multiple comorbidities who undergo coronary artery stenting, DOACs are increasingly used in combination with antiplatelets. To examine the safety of DOAC and antiplatelet combination therapy outside of a clinical trial setting, the team studied a cohort of 70,900 Medicare patients receiving coronary artery stents from 2010 to 2012. Reported in the Journal of Clinical Neuroscience, the team found that compared to antiplatelets alone, the excess bleed risk conferred by combination therapy is substantial, but similar to the alternative drug Warfarin. A finding, the researchers state that “underlines that choice of combination therapy should be tailored to individual patient characteristics, needs, and cost.”
The research was supported grants from the National Institute on Aging, the National Institutes of Health Common Fund, and by a Dartmouth SYNERGY grant: The Dartmouth Clinical and Translational Science Institute.
Samir Soneji study featured as one of ‘Year’s Major Achievements in Clinical Cancer Research and Care’
Research led by Dartmouth Institute Associate Professor Samir Soneji was selected by the American Society of Clinical Oncology for inclusion in Clinical Cancer Advances 2018, the Society's annual review of progress against cancer and emerging trends in the field. The study, "Association between initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis" is featured as one of the year's major achievements in clinical cancer research and care. Previous research by Soneji has found higher levels of online engagement were associated with higher susceptibility to tobacco use among youth 12-17 who had never used tobacco and those who had used it at least once.
Last year, a research team led by Dartmouth Institute Associate Professor Marie-Anne Durand received a $2-million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to compare care that incorporates the use of two decision aids-an Option Grid™ and a Picture Option Grid™ - with usual care received by women newly diagnosed with early-stage breast cancer (stages I to IIIA). The protocol for the multi-site, three-year What Matters Most trial recently was accepted and is currently in press with BMC Public Health. Patient recruitment for What Matters Most also is underway. Patient associates and research assistants have recruited 150 patients (out of an eventual 1,000) across the four planned study sites, including the Norris Cotton Cancer Center at Dartmouth-Hitchcock. The researchers hope to determine if women who are able to use decision aids during the course of their care are more meaningfully involved (with their physicians) in creating a treatment plan for themselves, have lower anxiety, less decision regret, and a higher quality of life than women who receive the usual care (that typically doesn't integrate decision aids).
Dartmouth Institute Professor Amber Barnato was a featured speaker at a panel discussion, "Health Spending: Tackling The Big Issues," in Washington, D.C., on Feb. 1. The event kicked off the "Health Spending" project. Sponsored by Health Affairs with support from the National Pharmaceutical Council, the project aims to promote an evidence-based conversation about health spending by exploring questions involving the level and growth rate of health spending, the distribution of spending, efforts to improve the value of care, and analysis of options for constraining health care costs. In her talk titled, "Spending, Value and the Patient Perspective," Barnato discussed current research on patient's perspectives on health care spending. "When patients think about spending and value, they think about different things than policy makers and clinicians," Barnato says. "They think about their out-of-pocket costs and tough decisions like whether to forgo heat, food, and rent, whether to spend down all of their savings, or whether they can leave a legacy to their children."