Chaperone use during Pap smears varies

When doctors were first encouraged to have a nurse or medical assistant in the room while collecting a Pap smear, it was so the patient would feel comfortable. In time, hospital lawyers began to advocate chaperones for legal protection.

Today, few guidelines and little consistency exist, leaving patients at the mercy of their doctor’s training, gender or geographic location.

A study by doctors at the U-M Health System found three-quarters of family physicians surveyed said they routinely use a nurse or medical assistant as a chaperone during Pap smears. But a woman living in the South is more likely to have a chaperone in the exam room while her doctor performs a Pap smear than is a woman living in the Midwest. At the same time, women who have male doctors will see an extra face in the room more often than women with female doctors.

The study, published in the Annals of Family Medicine, surveyed 5,000 members of the American Academy of Family Physicians, a trade group for that specialty. The lead researcher was Dr. Pamela Rockwell, clinical assistant professor of family medicine at the Medical School. The senior author was Mack Ruffin IV, associate professor of family medicine at the Medical School. Dr. Terrence Steyer of the University of South Carolina also was an author. The study was supported by numerous grants, including from the Research Committee of the U-M Department of Family Medicine.

Michigan’s sluggish economy will pick up speed in 2004-05

The ailing Michigan economy soon will be on the mend and will make a solid recovery during the next two years, U-M economists say.

“After three straight years of job losses, we expect a sustained employment rebound during 2004 and 2005 at a pace comparable to that of the second half of the 1990s,” U-M economist Joan Crary says. “The state’s private non-manufacturing sector has already begun to strengthen, posting job gains in each of the past two quarters, and manufacturing employment is projected to turn around early next year.”

In their annual forecast of the Michigan economy, Crary and colleagues George Fulton and Saul Hymans predict the state will gain 77,600 jobs during 2004 and 92,000 jobs during 2005—after losing nearly 87,000 jobs since the end of 2001.

Though the ongoing state budget crisis will constrain public-sector hiring in the short run, job prospects in the private sector should improve steadily and be widespread. Manufacturing employment in the state, which is expected to lose nearly 32,000 jobs this year, is expected to regain 11,600 jobs during each of the next two years, the forecasters say.

The forecast predicts unemployment in Michigan will move downward from 7.4 percent at the end of this year to 6.5 percent at the close of next year and then fall further to 5.7 percent 12 months later—which still is a full percentage point above the national average projected for the end of 2005.
—Bernie DeGroat, News Service

Computer-assisted breast imaging systems may help find cancers

New computerized systems that give doctors a second pair of eyes for looking at mammograms and other breast scans are showing great promise for detecting breast cancer, distinguishing it from benign problems without a biopsy and tracking changes in a woman’s breast over time.

The systems, all developed at the U-M Health System (UMHS), are in various stages of readiness for clinical use. UMHS researchers reported Dec. 1 that they have made significant progress in using computers to increase the accuracy of interpretation of digital mammograms and breast ultrasound images.

The team presented results from several of the computer-aided diagnosis (CAD) systems at the annual meeting of the Radiological Society of North America (RSNA).

One of the most encouraging results shows that a CAD system improved the ability of highly experienced radiologists to tell cancerous tumors from benign growths on ultrasound breast scans. Such scans often are performed after a suspicious finding on a screening mammogram, to help determine if a biopsy is needed. Associate research professor Berkman Sahiner presented the results in a talk at RSNA.

U-M’s CAD Research Laboratory team, in the Basic Radiological Sciences division of the Medical School’s Department of Radiology, has worked for more than a decade to develop CAD systems for breast imaging. Led by Heang-Ping Chan, team members work closely with clinicians in the U-M Breast Imaging Division, led by Dr. Mark Helvie, to evaluate new techniques on images from patients.
—Kara Gavin, UMHS Public Relations

Concentrated mutual funds perform better

Mutual funds perform better if their holdings are invested in fewer industries, according to a Business School study on the industry concentration of U.S. equity funds.

“Though actively managed funds vary substantially in their portfolio concentration, funds with more concentrated portfolios perform better than funds with more diversified portfolios,” says Clemens Sialm, assistant professor of finance. “This performance seems to be generated by a better stock-picking ability of managers.”

Sialm and colleagues Marcin Kacperczyk and Lu Zheng studied more than 2,000 actively managed diversified equity funds from 1984-99 and found that mutual funds with above-median concentration yield an average abnormal return of 2.18 percent per year before expenses and 0.82 percent per year after expenses. On the other hand, more diversified mutual funds yield an average abnormal return of 0.39 percent per year before expenses and -0.73 percent per year after expenses.

“Conventional wisdom suggests that mutual fund managers should widely diversify their holdings across industries to reduce their portfolio’s idiosyncratic risk,” says Zheng, assistant professor of finance.

“However, fund managers might want to hold concentrated portfolios if they believe that some industries will outperform the overall market or if they have superior information to select profitable stocks in specific industries.”
—Bernie DeGroat, News Service

Second opinion from major cancer center leads to more detection, treatment changes

Women with breast cancer who seek a second opinion on their mammograms from experienced specialists at a major cancer center frequently get a new plan for their care, a study shows. Some even learn that they have cancer in more locations than they thought.

After a consultation, 7 percent of all patients in the new study found out they had more cancer in the same breast—or a previously undiscovered tumor in the other breast. Many other patients received advice from the consulting physicians who altered their imaging or treatment plans.

These findings, made by a team at the Comprehensive Cancer Center, were presented Dec. 4 at the national meeting of the Radiological Society of North America.

Dr. Amy Rochester Guest, a lecturer in the Department of Radiology at the Medical School, led the study. The other authors are Drs. Mark Helvie, Marilyn Roubidoux, Michael Sabel, Alfred Chang and Celina Kleer.

—Kara Gavin, UMHS Public Relations