U-M reopens medical library without books

ANN ARBOR (AP) — The University of Michigan has reopened its Taubman Health Sciences Library after a $55 million overhaul and rethinking of how a library for medical students should function.

Hundreds of thousands of books were moved to an offsite location and are available on demand for delivery, and by becoming “bookless” the school said that frees up space for medical student education. The facility on the school’s Ann Arbor campus officially reopened over the weekend.

“Today’s library can be anywhere, thanks to technology, yet there is still a desire for a physical location that facilitates collaboration, study and learning,” Jane Blumenthal, associate university librarian and Taubman Library director, said in a statement.

The books were moved about two years ago, before construction began. The library includes a realistic simulated clinic and medical students will work with those studying public health, dentistry, pharmacy, social work, nursing and kinesiology — much like they will in their future careers.

The library also features a virtual cadaver, a life-sized display that’s manipulated using a touch screen to view different layers of the body, The Ann Arbor News reported. A scalpel tool can also be used to make incisions and even cut away portions of the body for inspection.

“This new space is truly designed by educators, and it shows in every detail,” said Dr. Rajesh Mangrulkar, associate dean for medical student education. “For example, students can write on erasable walls and tables to help facilitate discussions and teamwork.

“There’s supportive technology infused in every element, not so that it stands out, but so it’s an integral part of the learning environment.”

The 35-year-old, 143,400-square-foot library will serve as the central learning hub for the university’s nearly 780 medical students as well as provide lecture and advising space for the medical school’s more than 1,100 graduate students and postdoctoral fellows in biomedical sciences.

The school has a historical collection of medical books at the Hatcher Graduate Library.

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Medical journal news releases CAN make a difference

This week The BMJ sent journalists a news release, “Regular consumption of spicy foods linked to lower risk of death.” The second paragraph – the third sentence overall – of the news release read: “This is an observational study so no definitive conclusions can be drawn about cause and effect, but the authors call for more research that may “lead to updated dietary recommendations and development of functional foods.”

If you go to the journal article on which the news release is based, you see that the seeds of appropriate explanation were planted further upstream.

In the conclusion paragraph of the published study manuscript, the researchers wrote:

“given the observational nature of this study, it is not possible to make a causal inference.”

Did that clarity – that emphasis on the fact that association ≠ causation – make a difference in subsequent news stories based on the study or on the news release?  It appears that may be the case in this instance.

• TIME.com included this:  “More research is needed to make any causal case for the protective effects of chili—this does not prove that the spicy foods were the reason for the health outcomes.”
• The New York Times Well blog had a line: “The authors drew no conclusions about cause and effect.”
• With even greater emphasis, the Los Angeles Times reported: “Although the study included nearly half a million volunteers who were tracked for a total of 3.5 million person-years, the researchers emphasized that they couldn’t show a causal relationship between eating spicy foods and living longer.”
• In The Washington Post: “The researchers said that while it isn’t possible to draw any conclusions about whether eating spicy foods causes you live longer from their work that more studies are needed to look at this link in more depth.”
• From HealthDay: “However, the study authors cautioned that their investigation was not able to draw a direct cause-and-effect link between the consumption of spicy foods and lower mortality. They could only find an association between these factors.”
• CBSNews.com stated: “The authors emphasize that this is an observational study so no definitive cause and effect relationship can be drawn.”

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We’ve had a long-running challenge to news release writers for The BMJ and for news releases for others of the ~50 journals that BMJ publishes, to consistently state the limitations of observational studies that they write about.  And we’ve brought this up with other journals as well.

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In this latest chapter, kudos to The BMJ. The words matter.  What the researcher-authors submit matters. The journal’s editorial scrutiny matters.  The accuracy of the news releases matters as well.

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Music in operating theaters could impair communication

The study, published in the Journal of Advanced Nursing, investigates how background music impacted on surgical operations through an analysis of video recordings.

Co-lead author Sharon-Marie Weldon, from the Department of Surgery and Cancer at Imperial College London in the UK, explains that some background music can have a beneficial effect:

"Music can be helpful to staff working in operating theaters where there is often a lot of background noise, as well as other distractions - it can improve concentration."

Recently, Medical News Today reported on a study published in the Aesthetic Surgery Journal that found when surgeons listened to their preferred music, they closed their incisions more effectively.

However, the researchers found that music could disrupt communication between different members of theater teams. In some cases, surgeons had to repeat requests for instruments or supplies made to nurses. The researchers also found evidence of tension in some theater teams recorded on video.

Specifically, in cases where music was played, the researchers noted that repeated requests were five times more likely to occur than during operations without musical accompaniment. They estimate that each repeated request can add up to an extra minute to a procedure's duration and lead to frustration among clinical staff.

Music was first played in operating theaters in 1914 as a way of calming patients. Nowadays, experts estimate that music is played during 53-72% of surgical operations, with many modern theaters equipped with devices specifically for playing music such as MP3 players and portable speakers.

With most surgical patients anesthetized, music is now very much for the benefit of the medical staff.

Music decisions often made by senior medics

The researchers analyzed video recordings made of a total of 20 operations carried out over a period of 6 months in two operating theaters in the UK. Footage was obtained from multiple camera angles, allowing the researchers to examine both verbal and non-verbal communication in the theater teams.

Communication issues were exacerbated when alterations were made to the volume of the music. When digital tracks did not have a standard volume, turning up one popular song could lead to a subsequent song being played far too loudly.

"In the operating theaters we observed, it was usually the senior medics of the team who made the decision about background music," says co-lead author Dr. Terhi Korkiakangas. "Without a standard practice of the team deciding together, it is left up to junior staff and nurses to speak up and challenge the decisions of senior doctors, which can be extremely daunting."

Although the study only examined footage from two operating theaters, it does illustrate the potential problems that could be caused by the playing of music in operating theaters.

The authors state that the possibility that music could interfere with communication is seldom recognized as a potential safety hazard, and that frank discussions between surgical teams should be held - particularly taking into consideration the views of theater nurses.

Weldon concludes:

"We'd like to see a more considered approach, with much more discussion or negotiation over whether music is played, the type of music, and volume, within the operating teams."

At the start of the year, Medical News Today reported on a study suggesting that some emotional responses to music are the same worldwide, regardless of cultural diversities.

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Best Medical Schools Linked to Top-Notch Hospitals

At almost any medical school, soon-to-be doctors will get years of hands-on and classroom training in preparation for their careers. But there are perks that come with going to a school that's affiliated with a prestigious hospital.

"You get to see the medical cases that are really complex," says Sahil Mehta, a graduate of thePritzker School of Medicine at the University of Chicago, which is affiliated with NorthShore University HealthSystem. "You get to see a wide variety of disease." 

A school that is affiliated with a top-ranked hospital may give students the chance not only to see patients with routine needs, but also those who need advanced care, says Mehta, who's also the founder of MedSchoolCoach, a company that helps prospective medical students get into school. Plus, students can see leaders in various areas of medicine — such as oncology, radiology or surgery – who may work at such hospitals.

U.S. News recently released its 2015-2016 Best Hospitals rankings, and many of the hospitals on the Honor Roll, a list of hospitals that rank highly in at least half a dozen specialties, are also affiliated with schools that rank highly for research or primary care in the 2016 Best Medical Schools rankings.

Below are the 15 hospitals on the Honor Roll, and the medical schools that are affiliated with each.

Hospital (state)	U.S. News Best Hospitals Honor Roll rank	Affiliated medical school (name) (state)	U.S. News research rank	U.S. News primary care rank
Massachusetts General Hospital	1	Harvard University (MA)	1	12 (tie)
Mayo Clinic (MN)	2	Mayo Medical School (MN)	27	42 (tie)
Johns Hopkins Hospital (MD)	3 (tie)	Johns Hopkins University (MD)	3 (tie)	29 (tie)
UCLA Medical Center​	3 (tie)	University of California—Los Angeles (Geffen)	13	7
Cleveland Clinic	5	Case Western Reserve University (OH)	24	62 (tie)
Brigham and Women's Hospital (MA)​	6	Harvard University (MA)	1	12 (tie)
New York-Presbyterian University Hospital of Columbia and Cornell	7	Columbia University (NY)	8 (tie)	52 (tie)
New York-Presbyterian University Hospital of Columbia and Cornell	7	Cornell University (Weill) (NY)	18	49 (tie)
UCSF Medical Center	8	University of California—San Francisco	3 (tie)	3
Hospitals of the University of Pennsylvania-Penn Presbyterian	9	University of Pennsylvania (Perelman)	5	12 (tie)
Barnes-Jewish Hospital/Washington University (MO)	10	Washington University in St. Louis	6	19 (tie)
Northwestern Memorial Hospital (IL)​	11	Northwestern University (Feinberg) (IL)	19	29 (tie)
NYU Langone Medical Center	12	New York University	14 (tie)	42 (tie)
UPMC-University of Pittsburgh Medical Center	13	University of Pittsburgh	16	19 (tie)
Duke University Hospital (NC)	14	Duke University (NC)	8 (tie)	29 (tie)
Stanford Health Care-Stanford Hospital (CA)	15	Stanford University (CA)​	2	25 (tie)

Medical schools often have relationships with several hospitals, where students get experience working in different specialties and with different kinds of patients.

Harvard University, for example, has a partnership with Massachusetts General Hospital, ranked No. 1 on the Honor Roll; Brigham and Women's Hospital, which is ranked No. 6; and other medical facilities.

Hospitals can also have partnerships with more than one school. Both Cornell University and Columbia University are affiliates of New York-Presbyterian University Hospital of Columbia and Cornell, ranked at No. 7.

[Follow a timeline to learn when to apply to medical school.]

​If students attend a medical school that's not associated with a big, highly ranked​ hospital and is instead partnered with a more community-based hospital​, they shouldn't think it's the end of the world, says Mehta, who is completing a fellowship at Massachusetts General Hospital. At a community hospital, students can get a solid understanding of how to practice medicine​.

"Sometimes for a med student it's actually nice to see basic cases to really get a good, solid foundation, and then build upon that in residency and then in fellowship after that," Mehta says. Students may also be able to "get their hands dirtier" while training in community hospitals, which may have fewer​ residents and fellows, he says.

[Think carefully about the pros and cons of hiring a medical school admissions consultant.]

At many schools, students also have the option of spending time at several different kinds of medical centers, and they can get experience at hospitals that are not partnered with their schools by doing what's called an away rotation.

Prospective students should consider a range of factors beyond a school's hospital affiliation, experts say, when deciding where to go, such as what they might want to practice and if they want a dual-degree program.

"They should never choose a school just based on rankings, whether it's based on the rankings of the school itself or based on the hospital that they're affiliated with," says Mehta. "Choosing a school just based on rankings is a recipe for disaster."

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High-dose vitamin D supplements 'do not improve bone health' for postmenopausal women

The results of the randomized clinical trial comparing the effects of low-dose vitamin D supplementation, high-dose vitamin D supplementation and placebo are published in JAMA Internal Medicine.

Vitamin D plays a key role in the regulation of calcium and phosphorus absorption and the maintenance of healthy bones and teeth. Individuals that do not get enough vitamin D are susceptible to osteoporosis due to reduced calcium absorption.

Studies have shown that nearly half of postmenopausal women sustain an osteoporotic fracture, with falling estrogen levels also a factor in osteoporosis development. The prevalence of this condition suggests that vitamin D supplementation is particularly important to this group.

Vitamin D insufficiency is also estimated to affect around 75% of postmenopausal women in the US, according to the authors of the study.

The optimum level of vitamin D for skeletal health is still up for debate, however. While the Institute of Medicine (IOM) recommend levels of 20 ng/mL or greater, others believe that vitamin D levels should be at least 30 ng/mL.

To investigate, Dr. Karen E. Hansen, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues recruited a total of 230 postmenopausal women with vitamin D insufficiency - defined as a vitamin D level of 14-27 ng/mL.

Participants were randomly assigned into one of three groups. One group received a high dose of cholecalciferol - a form of vitamin D - that achieved and maintained vitamin D levels at 30 ng/mL and above. The other groups received low-dose cholecalciferol and placebo, respectively.

High-dose supplementation did not decrease total number of falls

For 1 year, the researchers recorded changes in calcium absorption, bone mineral density, muscle mass and sit-to-stand tests among the participants.

Although the researchers observed a 1% increase in calcium absorption in the high-dose group compared with 2% and 1.3% decreases in the low-dose and placebo groups, respectively, the high-dose was not considered to offer an overall benefit as no differences were found between the three groups in changes to bone density, muscle mass or sit-to-stand tests.

Even without improvements in these areas, the authors write that high-dose vitamin D supplementation could be justified if it reduced the numbers of falls, as these typically precede osteoporotic fractures.

However, no differences were found between the three groups in the number of falls that occurred among participants, the amount of physical activity they carried out or in functional status.

"Although we found no significant increase in bone resorption or decreases in [bone mineral density] associated with high-dose cholecalciferol, the benefits of high-dose cholecalciferol were too small to justify its routine use," the authors conclude.

The authors note that their findings are limited by the number of people that took part in the trial. Few African-Americans took part and all participants were aged 75 or younger. The findings may not, therefore, be generalizable to people inadequately represented by the participants.

In an accompanying editor's Note, Dr. Deborah Grady, deputy editor of JAMA Internal Medicine, states:

"It is possible that treatment beyond 1 year would result in better outcomes, but these data provide no support for use of higher-dose cholecalciferol replacement therapy or indeed any dose of cholecalciferol compared with placebo."

To learn more about the health benefits and recommended intake of vitamin D, visit Medical News Today's Knowledge Center article.

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Young dads at greater risk of death in middle age, study suggests

Study author Dr. Elina Einiö, of the University of Helsinki in Finland, and colleagues note that previous studies have suggested young fatherhood is linked to poorer physical health in midlife, leading to earlier death than men who become fathers later in life.

However, the authors say the credibility of this association has been unclear; such studies say it is driven by genes, family environment and socioeconomic factors in early life - factors that affect both mortality and young fatherhood.

For their study, Dr. Einiö and colleagues set out to determine whether there may be a causal link between young fatherhood and risk of early death.

To reach their findings, the team analyzed data drawn from the 1950 Finnish census that involved more than 30,500 men who were born between 1940 and 1950. All men had become fathers by the age of 45, and using 1985-2005 mortality data, the men were tracked from the age of 45 until death or until the age of 54.

Fatherhood before age 22 linked to 26% higher death risk in midlife

Around 15% of the men had become fathers by the age of 22, while 29% were fathers by the ages of 22-24, 18% by the ages of 25-26, 19% by the ages of 27-29 and 19% became fathers between the ages of 30 and 44.

The average age of first-time fatherhood was 25-26, according to the study authors, so men in this age group were used as a reference for their findings.

During the 10-year study period, around 1 in 20 fathers died, with around 21% dying from ischemic heart disease and 16% from alcohol-related causes.

Compared with men who became fathers at the ages of 25-26, those who became dads by the age of 22 were found to be at 26% greater risk of death during midlife, while men who had their first child between the ages of 22-24 were at 14% greater risk of death in middle age.

However, men who became first-time fathers between the ages of 30 and 44 were found to be at 25% lower risk of death during midlife, compared with men who had their first child aged 25 or 26.

Becoming a father between the ages of 27 and 29 appeared to have no influence on midlife mortality.

These findings remained after accounting for influential factors, such as fathers' educational attainment, area of residence, marital status and number of children.

The team also analyzed the mortality risk of 1,124 brothers who were fathers. They found - compared with siblings who became fathers by the age of 25 or 26 - those who had their first child by the age of 22 were around 73% more likely to die during middle age, while those who became fathers aged 22-24 were at 63% greater risk of death during midlife.

Brothers who became fathers between the ages of 30 and 44, however, were found to be at 22% lower risk of death during middle age, compared with those who had their first child aged 25-26.

These results remained even after the researchers accounted for brothers' year of birth, educational attainment, marital status, area of residence, number of children and shared circumstances in early life.

Findings indicate a causal link between young fatherhood and early death

The researchers say their findings suggest a likely causal link between young fatherhood and greater risk of death in middle age. "The association was not explained by unobserved early-life characteristics shared by brothers or by certain adulthood characteristics known to be associated both with fertility timing and mortality," they note.

While the team is unable to pinpoint the exact mechanisms behind the findings observed in this study, Dr. Einiö told Medical News Today that it may be down to the stress of fatherhood at such a young age.

"We know based on other studies that many pregnancies were unplanned and young parents often decided to form a new household at that time," she said. "It is possible that suddenly taking on the combined role of father and breadwinner may have caused considerable psychological and economic stress for a young man not ready for his new role. Of course, not all the children of young fathers were unplanned, but many were."

As such, Dr. Einiö told MNT it is important that men who become fathers at a young age take care of themselves:

"Despite the responsibilities of fatherhood, young fathers, who reside with their child, should find the time for good health behaviors, such as physical exercise to improve their future health."

Another fatherhood study published last month found men gained an average of 4.4 Ib in weight after their first child, while over the same study period, the average man who did not have a child lost around 1.4 Ib in weight.

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FDA approve dual gastric balloon for treatment of obesity

The device comprises two balloons that are inserted into the stomach and inflated without the need for surgery. The device is meant to be a temporary measure and should be removed after 6 months. Removal is also via a non-surgical procedure.

The US Food and Drug Administration (FDA) note that the ReShape Integrated Dual Balloon System:

"... likely works by occupying space in the stomach, which may trigger feelings of fullness, or by other mechanisms that are not yet understood."

The Dual Balloon does not alter the anatomy of the stomach.

To help achieve and maintain weight loss, patients implanted with the Dual Balloon are advised to follow a medically supervised diet and exercise plan both while the device is in place and then for 6 months after it is removed.

The device is inserted during an outpatient visit. The procedure lasts no more than half an hour and is performed while the patient is under mild sedation.

A trained physician inserts the deflated balloons using an endoscope. This is a tube with a camera on the end that goes into the mouth, down the throat and into the stomach. The camera allows the physician to guide the placement of the deflated balloons.

Once in the stomach, the physician inflates the balloons by filling them with a sterile salt solution and then releases them and removes the endoscope.

The device is for obese adults whose body mass index (BMI) lies in the range 30-40 kg/m². It is intended for patients who have not been able to lose weight through diet and exercise alone and is limited to those with one or more obesity-related conditions such as high blood pressure, high cholesterol and diabetes.

Trial participants lost 14 lbs on average

For the approval, the FDA reviewed a clinical trial of 326 obese patients aged from 22 to 60 whose BMI was in the range 30-40 kg/m² and who had at least one obesity-related condition.

The trial randomly assigned the patients to either have the Dual Balloon inserted, or to undergo an identical "dummy" endoscopic procedure but where the device was not fitted.

The results showed that at the end of 6 months, when the device was removed, the 187 patients who were fitted with the Dual Balloon on average lost 14.3 lbs (6.5 kg), equivalent to 6.8% of their body weight.

In contrast, the control group on average lost 7.2 lbs (3.3 kg, 3.3% of their body weight).

And 6 months after the device was removed, the group that had it fitted managed to keep off an average of 9.9 lbs (4.5 kg) of the 14.3 lbs they lost.

The insertion procedure may have side effects. These include muscle pain, nausea and headache. In rare instances, this may also lead to severe allergic reaction, tearing of the esophagus, infection, breathing problems and heart attack. Once the Dual Balloon is inserted, patients may also experience nausea, vomiting, feelings of indigestion, abdominal pain and stomach ulcers.

Patients who have had bariatric or other kinds of gastrointestinal surgery should not be fitted with the device, and neither should patients diagnosed with inflammatory intestinal or bowel disease, who have symptoms of delayed gastric emptying or active H. pylori infection, or who have a large hiatal hernia. Pregnant women and patients taking aspirin every day should also avoid it, the FDA advises.

Device 'fills a significant gap'

"Many Americans have struggled with a lack of effective weight loss options when their BMI is in the 30-40 range," states Dr. John Morton, President of the American Society for Metabolic and Bariatric Surgery.

He says options like the ReShape Dual Balloon address a significant gap that exists between diet and exercise on the one hand and weight loss medications and surgery on the other.

The following video shows an animation of the insertion and removal of the ReShape Dual Balloon, which is made by ReShape Medical Inc., in San Clemente, CA.

Dr. William Maisel, acting director of the FDA Center for Devices and Radiological Health's Office of Device Evaluation says for obese patients to achieve significant weight loss and keep it off, they often need to combine solutions, including improving their diet and taking more exercise. He says that:

"This new balloon device provides doctors and patients with a new non-surgical option that can be quickly implanted, is non-permanent, and can be easily removed."

Meanwhile, Medical News Today recently learned how a compound that mimics the effect of exercise may offer new treatments for obesity and type 2 diabetes.

In the journal Chemistry & Biology, researchers describe how mice fed a high-fat diet that were given a single dose of the compound daily for 7 days, improved their glucose tolerance and shed about 5% of their body weight.

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Warning about the dangers of measles may sway vaccine skeptics

Published in the Proceedings of the National Academy of Sciences, the study suggests reminding people how deadlymeasles can be and that the measles, mumps and rubella (MMR) vaccine can protect their children may encourage vaccination.

However, telling vaccine skeptics that their concerns about vaccine safety are inaccurate and uninformed is unlikely to sway their views, finds the research.

According to a report from the Centers for Disease Control and Prevention (CDC), 79% of measles cases in last year's outbreak occurred among individuals who chose not to receive the MMR vaccine due to personal beliefs - particularly worries about its safety.

"Myths about the safety of vaccinations have led to a decline in vaccination rates and the re-emergence of measles in the United States, calling for effective provaccine messages to curb this dangerous trend," say senior author Keith Holyoak, professor of psychology at University of California-Los Angeles (UCLA), and colleagues.

The researchers note that previous studies on the attitudes toward vaccination indicate that it is hard to change perceptions of vaccine safety among skeptical individuals. But in this latest study, the team identified an approach that they say could encourage positive attitudes toward vaccination.

A nonconfrontational approach more effective for encouraging vaccination

To reach their findings, Prof. Holyoak and colleagues enrolled 315 adults from the US. Around a third of participants had favorable attitudes toward vaccination, while the remaining participants held some degree of skepticism toward vaccination. Around 10% of skeptics had significantly negative attitudes toward vaccines.

The participants were randomly assigned to one of three groups, with positive and negative attitudes toward vaccination represented equally in each group.

In one group, participants were asked to read material from the CDC stating that all children should receive the MMR vaccine and that it is effective and safe. The CDC material also explained that while many parents worry that the vaccine causes autism, many studies have shown there is no such association.

Another group was provided with materials that explained the dangers of measles, mumps and rubella and stated that the MMR vaccine can protect against these conditions. In addition, the participants read a statement from a mother whose 10-month-old son's life was threatened after contracting measles.

The final group acted as a control group. Here, participants were required to read material about feeding birds.

The researchers found that among individuals who were skeptical about vaccination, only those who were given materials explaining the dangers of disease and the protection vaccination can provide developed more positive attitudes toward vaccination. Skeptics who were given CDC material experienced no change in vaccination attitudes.

"It's more effective to accentuate the positive reasons to vaccinate and take a nonconfrontational approach - 'Here are reasons to get vaccinated' - than directly trying to counter the negative," explains Prof. Holyoak. "There was a reason we all got vaccinated: Measles makes you very sick. That gets forgotten in the polarizing debate on whether the vaccine has side effects."

The vaccination attitudes of both parents and non-parents in each of the three groups were affected in exactly the same way, according to the team.

The researchers say their findings suggest there may be more effective ways to boost vaccination support in doctors' offices, by showing families videos depicting the dangers of disease, for example, or by doctors adopting a nonconfrontational approach when talking to individuals who have negative attitudes toward vaccination.

Co-lead study author Derek Powell, a psychology graduate at UCLA, adds:

"People who are skeptical about vaccines are concerned about the safety of their children. They want their kids to be healthy. That's also what doctors want. Instead of fighting their misconception, remind them why the vaccine is the best way to keep their kids safe."

In February, a Spotlight from Medical News Today took an in-depth look on whether ongoing concerns about vaccine safetyare to blame for the measles epidemic.

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