skip navigation nih record
Vol. LXV, No. 2
January 18, 2013
cover

previous story



Digest

Coordinated Care Can Address Disabled Adults’ High Rates of ER Use

Working-age adults with disabilities account for a disproportionately high amount of annual emergency department visitors, an NIH comparison study has found. As emergency department care may not be the best to address nonurgent concerns and is higher in cost, finding a way to decrease these visits is of interest to many stakeholders.

One of the first detailed looks at this population’s heightened use of urgent care, the NIH study published online in Health Services Research on Dec. 26, 2012, analyzed pooled data from the Medical Expenditure Panel Survey. Researchers found access to regular medical care, health profile complexity and disability status contributed to people with disabilities’ use of the emergency department. To address this disparity, the authors recommend enhanced communication between emergency department and primary care physicians and tailored prevention and primary care programs.

“We want to understand what takes people to the emergency department to learn if their care could be better managed in other ways,” said Dr. Elizabeth Rasch, chief of the epidemiology and biostatistics section in the Clinical Center’s rehabilitation medicine department. “While many of those visits may be necessary, it is likely that some could be avoided through better information-sharing among all of the health care providers who see a particular individual.”

The study found that, despite representing 17 percent of the working-age U.S. population, adults with disabilities accounted for 39.2 percent of total emergency room visits. Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the department more than 4 times per year. Emergency visits were also associated with poor access to primary medical care, which was more prevalent among adults with disabilities.

Benefits of Higher Oxygen, Breathing Device Persist After Infancy

By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, according to a study by an NIH research network.
By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, according to a study by an NIH research network.

By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, according to a follow-up study by an NIH research network that confirms earlier network findings. Moreover, infants treated with a respiratory therapy commonly prescribed for adults with obstructive sleep apnea fared as well as those who received the traditional therapy for infant respiratory difficulties, the new study found.

“CPAP [continuous positive airway pressure] for infants has been available since the 1970s,” said senior author Dr. Rosemary D. Higgins of NICHD; NHLBI also supported the study. “This is the first study to compare surfactant treatment to CPAP in a large group of infants, and these results reassure us that CPAP is as good a choice in the first hour of life as traditional methods for very preterm babies who need help breathing. We’ve also confirmed that higher oxygen targets improve survival and don’t appear to threaten survivors’ vision in the longer term.”

The findings appeared in the New England Journal of Medicine.

Gene Variation May Shape Bladder Cancer Treatment

Patients who have inherited a specific common genetic variant develop bladder cancer tumors that strongly express a protein known as prostate stem cell antigen (PSCA), which is also expressed in many pancreatic and prostate tumors, according to NIH research.

A therapy targeting the PSCA protein on the tumor cell surface is under evaluation in clinical trials for prostate and pancreatic cancer. The researchers hope that this therapy will be tested in bladder cancer patients with the genetic variant, which could help reduce potentially harmful side-effects, lower costs and improve treatment efficacy.

“We’ve been pursuing this mechanism for some time now,” said NCI’s Dr. Ludmila Prokunina-Olsson, senior author of the paper. “It started with our early results from the initial genomewide association study that revealed a marker in the PSCA gene related to bladder cancer risk. This latest work reveals how a specific letter change in DNA influences protein expression at the cell surface. The big payoff is that a simple genetic test can determine which patients could benefit from anti-PSCA therapy.”

The paper appeared Jan. 3 in the Journal of the National Cancer Institute.


back to top of page