A Johns Hopkins team has developed SUDS — a device for cleaning ER equipment that wipes out dangerous bacteria and keeps it from returning for several days.  The Caring Connection will help you find advance directive forms and instructions for your state.

Research Reports

• People with Lynch syndrome don’t benefit from either aspirin or resistant starch (Novelose) even when aspirin is given at a high dose of 600 mg a day.  Over four years, Lynch patients on aspirin, Novelose, or a combination of the two had no fewer polyps than clinical trial participants on placebo.  Serious adverse events, gastric bleeding, strokes, and heart attacks, weren’t any different between the two groups either.  Dr. John Burn and the CAPP2 team report their results in the New England Journal of Medicine, December 11, 2008.
• Almost 9 out of 10 patients in treatment asked about cancer-related advertising directed at consumers had seen ads, mostly on television.  A majority of surveyed patients felt that the ads made them “aware of treatments they did not know about“, presented information “in a balanced manner“, and helped them have “better discussions” with their doctor.  One in ten felt that the ads reduced their confidence in their doctor’s judgment.  Of those who were aware of ads, 1 in 5 discussed an advertised medicine with their doctor, but of those only 20 percent actually received a prescription for the drug. Gregory A. Abel and the team at Harvard Medical School report the results of the survey in an early online edition of the Journal of Clinical Oncology August 3, 2009.
• People prone to colorectal polyps who were “super-compliers” in following a recommended low-fat, high-fiber diet with high amounts of fruits and vegetables had 35 percent fewer new polyps than people who were not on the diet at all.  However, most trial participants didn’t report that level of compliance.  Of 1,900 people in the trial, only 210 consistently reported success in following all three diet recommendations:  low fat, high fiber, and high fruit/vegetable intake.  Dr. Leah B. Sansbury and her team from the Polyp Prevention Trial Study Group reported their results in the American Journal of Epidemiology online July 30, 2009.

Other Headlines

• A team at Johns Hopkins has developed a device, similar to a shower cubicle, that can clean and decontaminate hard-to-clean emergency room equipment from electrocardigram machines to  cell phones.  SUDS or  the Self-cleaning Unit for the Decontamination of Small instruments beats manual scrubbing for removing bacteria and keeping it away for at least two days.  Two days after manual cleaning, 1 in 4 devices had new bacterial growth, but SUDS-cleaned devices were bacteria-free even in heavy ER settings.  Treatment inside the 7 foot high SUDS machine didn’t appear to damage electronics, and its use can replace expensive  and wasteful disposables.  Development and testing of the SUDS device is described in Annals of Surgical Innovation and Research, online July 30, 2009.
• Caring Connections, a program of the National Hospice and Palliative Care Organization, provides free advance directives and instructions for each state that can be downloaded and filled out.  The packets include information about the HIPAA Privacy Rule and the specific forms and information you’ll need for your own state.  Depending on the state, advance directives allow you to appoint an advocate or proxy to make health care decisions if you are unable to speak for yourself and to specify what health care you do or do not want if you are critically ill.

Comparing Screening Methods for Average Risk Patients

Tests that Detect Adenomatous Polyps and Cancer

Colonoscopy

Most sensitive test for small and large polyps and cancers. Examines the entire colon, polyps can be removed and biopsied during the procedure.

Expensive, requires complete bowel cleansing. Normally uses sedation and requires someone to accompany patient, Rare instances of bowel perforation and bleeding. May not be covered by insurance.

Double-contrast barium enema

Every 5 years

Visualizes the entire colon, can detect most cancers, and the majority of large polyps. Helps patients who cannot complete a colonoscopy or where colonoscopy is not medically appropriate. Less expensive.

Requires complete bowel preparation. May be uncomfortable. An experienced radiologist is critical to quality exam. Colonoscopy is still required to biopsy lesions or removed polyps.

CT-colonography (virtual colonoscopy)

Every 5 years

Does not require sedation. No recovery time, patients can drive home or return to work. Finds cancer and large polyps at the same rate as colonoscopy. May find problems outside the colon as well.

Requires complete bowel preparation. Colonoscopy is required to biopsy and remove polyps. Technology and radiologist training are growing but not complete. May not detect non-polypoid colorectal neoplasms. May not be covered by insurance. False-positive problems identified outside the colon may require unnecessary follow-up tests.

Flexible sigmoidoscopy

Every 5 years

Can be done by primary care physician or trained nurse practitioner. Does not require sedation

Will miss polyps or cancers in the right colon beyond the reach of the scope. If polyps are found, colonoscopy and addition bowel preparation are required. Can be uncomfortable.

Tests that Primarily Detect Cancer

gFOBT: Guaiac-based stool test

Every year

Not very sensitive to polyps, will miss some cancers. Needs to be done correctly over three days. Requires diet and drug restrictions. Patients must handle stool. Has a high false positive rate that requires follow-up colonoscopy for about 1 in 3 tests.

FIT: Immunochemical stool test

Will miss some cancers and most advanced polyps. More expensive than gFOBT. All positive tests require colonoscopy follow-up.

Done at home privately. Not necessary to handle stool. Collection kit shipped directly to patient. No special diet prep required.

May not find all cancers or large polyps. Requires prompt, ice-pack shipment to special labs. Significantly more expensive than gFOBT or FIT. Colonoscopy follow-up necessary for positive test.