Soy Food Intake and Breast Cancer Survival
(Shu Os, Zheng Y, Et Al: Jama, 2009;302 (December): 2437-2443)

Objective: To evaluate the association of soy food intake after diagnosis of breast cancer with total mortality and breast cancer recurrence.

Participants: 5042 female breast cancer survivors in China from the Shanghai Breast Cancer Survival Study.

Results: During themedian follow-up of 3.9 years, 444 deaths and 534 recurrences were documented in 5033 surgically treated breast cancer patients. Soy food intake, as measured by either soy protein or soy isoflavone intake, was inversely associated with mortality and recurrence.

Conclusions: Amongwomenwith breast cancer, soy food consumptionwas significantly associated with decreased risk of death and recurrence.

Kevin's Comments: Concern has been raised in the past about the safety of soy products in breast cancer survivors since soy isoflavones have demonstrated estrogen-like properties. This concern has been heightened because soy isoflavones have been added to many foods and beverages. However, this study is reassuring and actually demonstrated an inverse relationship between soy food intake and breast cancer mortality and recurrence. Thus, breast cancer survivors can be reassured that these products are safe and may in fact decrease the likelihood of recurrence. However, we have no research proving the safety of soy dietary supplements, so the best advice at this time is to make sure ingested soy is consumed in food and not in dietary supplements.

The On-Road Difficulties of Older Drivers and Their Relationship iwth Self-Reported Moter Vehicle Crashes.
(Wood, JM, Anstey, KJ, Et Al: Journal of The American Geriatrics Society, 2009: 57 (November): 2062-2069

Objective: To quantify the driving difficulties of older adults using a detailed assessment of driving performance and to link this with self-reported retrospective and prospective crashes.

Participants: This was a prospective study in which the participants were subjected to an on-road driving assessment and results were obtained using a standardized measure of driving performance.

Results: Lane positioning, approach, and blind spotmonitoring were themost common maneuvering. Drivers reporting more retrospective or prospective crashes made significantly more driving errors. Driver instructor interventions during self-navigation(where the instructor had to brake or take control of the steering to avoid an accident) were significantly associated with higher retrospective and prospective crashes; every instructor intervention almost doubled prospective crash risk.

Conclusion: These findings suggest that on-road driving assessment provides useful information on older driver difficulties, with the self-directed component providing the most valuable information.

Kevin's Comments: Any doctor will tell you that one of the most difficult things to do inmedical practice is telling an older adult driver that it is no longer safe to drive. I have actually had the experience of a patient wanting to switch doctors when I told him he should no longer drive. Many communities now have driver safety evaluations available through the local community hospital or other therapy groups. An independent driver safety evaluation can help take “the heat” off the doctor or family members who suggest that the keys be taken away. In some cases, there may be issues that can be remedied through a driver safety course. For a small fee, AARP offers an online driver safety program at www.aarpdriversafety.org.

Physician Evalutation and Management of Medicare Home Health Patients
Wolff JL, Meadow A, Et Al: Med Care 2009; 47 (November): 1147-1155

Objective: To describe the rate of physician evaluation ofMedicare home health patients.

Methods: Medicare databases were used that linked physician office billings to 70,462 home care episodes. The rate of physician evaluation andmanagement visits was determined among those patients who received home care.

Results: About 1/3 of participants received no visits with their physician while they were receiving home care. Very few had a house call performed. The patients who did see their physician while receiving home care weremore likely to complete their home care and less likely to end up being sent back to the hospital.

Conclusion: Patients who visit their physician while receiving home care or who receive a house call are less likely to end up back in the hospital andmore likely to complete their home care.

Kevin's Comments: The important role that the patient’s physician has in care transitions is demonstrated here. Home health companies that require patients to visit their doctors while receiving home care are more likely to complete their home care and less likely to be re-hospitalized. This is yet another study that demonstrates that good care translates into positive business outcomes.