Effectiveness of Digital Breast Tomosynthesis Compared with Digital Mammography

In this article, the research team looked to determine whether improved initial outcomes of using DBT could be sustained over time.  The study was completed over 4 years and included 44,468 screenings attributable to 23,958 women.  The research team looked to compared recall rates, cancer cases per recalled patients, and biopsy and interval cancer rates.  Each women was followed over the course of 4 years and received either 1, 2, or 3 DBT screenings.  The number of screenings were then used as an intervention to determine the patient’s health.

The results of the study showed that the use of DBT remained significantly reduced compared with using digital mammography alone.  Overall, the study found that digital breast tonosynthesis outcomes are not only sustainable but provide significant recall reduction and a decline in interval cancers.

McDonald ES, Oustimov A, Weinstein SP, et al.  Effectiveness of digital breast tomosynthesis compared with digital mammography.  JAMA Oncol. doi:10.1001/jamaoncol.2015.553.  

(Article was published online first.)

Depression: An Increased Need for Screenings in Primary Care Settings

Depression is found to be one of the leading causes of disability for people in the United States that are 15 and older. Depression is also commonly seen in primary care settings, and is very common in older adults and in women that are pregnant or that just gave birth. In pregnant and post-partum women in particular, it is a large concern because it not only affects the mother, but the child as well. The USPSTF has found that screening adults for depression has greatly improved the identification of adults suffering from depression that came into the primary care setting. Some common screening techniques to use are the Patient Health Questionnaire, the Geriatric Depression Scale in older adults, and the Edinburgh Postnatal Depression Scale in pregnant or postpartum women. After screening, appropriate and common treatments of depression include antidepressants or psychotherapy, either alone or combined. The study also found that treating adults with depression that was identified through screening has lead to decreased morbidity in these patients, and the USPSTF recommends screening for the general adult population, which is all patients over the age of 18, with particular emphasis on pregnant and postpartum women.

JAMA. 2016;315(4):380-387

I chose this article because depression is becoming more and more prevalent in our country. We see this firsthand in the pharmacy with all of the depression and anxiety medications that we dispense, and have even seen proof in our Professions of Pharmacy class with the depression medications that have made it to the Top Drugs list. However, with all of the depression and associated medications that we do see, it is scary to me to hear that there are still so many cases of depression that go un-diagnosed. I believe that having greater screenings for patients that are known to be more prone to depression is important because it will prevent their illness from spiraling out of control while no one knows it is happening. I do not believe that medications should be used in every instance of depression or anxiety, and think that therapy is also a valid option to try, but whatever a patient needs is what they should receive because the primary goal of all health care professionals is to help patient get better, and the first step to that is knowing that there is a problem present.

Pharmacist-led screening program for an inner-city pediatric population

This study was conducted to see how inner city children are affected by asthma, hypertension, obesity, and environmental tobacco smoke (ETS) exposure. This study took place in lower socioeconomic communities throughout Pittsburgh and pharmacists and student pharmacists ran 12 health screenings on 144 children over the course of 2 years.

The study found that 16% of the children were already diagnosed with asthma before the screenings, and 18% had potential asthma. More than half of the children were not at a healthy weight (0.7% were underweight and the remaining were either overweight or obese), and 24% had abnormal blood pressure. 26% of the children had exposure to ETS comparable to that of smokers.

Over the course of this study, nearly 200 referrals were made by the pharmacists. This study is important because it shows how at risk the children in our own community are for conditions that could greatly affect their health outcomes. It also shows how critical of a role pharmacists could play in screening and preventing diseases among children who face numerous health disparities. Screening programs such as this can be implemented by pharmacists in other communities, especially those of even lower socioeconomic status than the one studied, to help lower health disparities among inner city populations of children.

Elliott JP, Harrison C, Konopka C, et al. Pharmacist-led screening program for an inner-city pediatric population. J Am Pharm Assoc. 2003;55:413-8.