The extent to which higher health care spending produces better patient outcomes is unclear. In a longitudinal cohort study of 387 757 patients in Ontario, Canada, who had an incident hospital admission for acute myocardial infarction, congestive heart failure, hip fracture, or colon cancer, Stukel and colleagues found that higher hospital spending intensity—which included higher intensity nursing and greater use of specialists and procedures—was associated with lower mortality, readmissions, and cardiac event rates during 1-year follow-up. In an editorial, Joynt and Jha discuss the relationship between inpatient care costs and quality and implications for health policy.
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Antibiotic treatment of Shiga toxin–producing Escherichia coli (STEC) infection is discouraged because it may increase the risk of hemolytic uremic syndrome; however, patients colonized with enteropathogenic bacteria are considered infective as long as bacteria are detected in the stool. In an analysis of data from 65 patients with STEC infection—22 of whom received oral azithromycin—Nitschke and colleagues found that compared with patients not receiving antibiotic treatment, patients receiving azithromycin had a lower frequency of long-term (>28 days) STEC carriage.
Patients with infected necrotizing pancreatitis often require surgical necrosectomy, which is associated with substantial morbidity. In a randomized trial of 22 patients with suspected or confirmed infected necrotizing pancreatitis, Bakker and colleagues found that compared with surgical necrosectomy, transgastric endoscopic necrosectomy—drainage and direct retroperitoneal endoscopic necrosectomy through the gastric wall performed while the patient was under conscious sedation—was associated with a reduced proinflammatory response and a lower risk of major complications. In an editorial, Hines and Donald discuss operative management strategies in patients with infected necrotizing pancreatitis.
Neuroblastoma is diagnosed over a wide age range, and older age at diagnosis is associated with poorer survival. In an investigation that involved whole-genome sequencing of DNA from tumors and matched germline samples from 104 patients with metastatic neuroblastoma, Cheung and colleagues found that ATRX mutations were present in tumors diagnosed in young adults, adolescents, and children, but not tumors from infants younger than 18 months at diagnosis.
In a systematic review of the literature, Srygley and colleagues identified clinical features and diagnostic tests useful in distinguishing acute upper gastrointestinal (GI) from acute lower GI bleeding, and beneficial in risk stratification of patients needing urgent intervention. Among the authors' findings were that melena, bloody or “coffee ground” nasogastric lavage, and a blood urea nitrogen:creatinine ratio of more than 30 are associated with an increased likelihood of an upper GI bleed. The Blatchford clinical prediction score is useful for identifying patients who do not require urgent intervention.
A young woman sustained multiple severe injuries in a motor vehicle crash. During her hospitalization, she developed a rapidly expanding and necrotic facial eschar. What would you do next?
Research on potentially dangerous strains of H5N1 influenza virus has sparked an international debate.
Transparency reports of industry payments to physicians and hospitals
Genomics and health care costs
Preventing depression: a global priority
“One day . . . I received an e-mail from my urologist. . . . In that moment my attitude about PSA screening changed dramatically.” From “Underestimating the Value of Reassurance.”
Health care and the road to the presidency: The JAMA Forum
Dr Bauchner summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
How would you manage a 75-year-old woman in complete clinical remission after stage IIIC epithelial ovarian cancer? Read the case at www.jama.com. Submit your response by April 1 for possible online posting.
Join David S. Ludwig, MD, PhD, March 21, from 2 to 3 PM eastern time to discuss weight loss strategies for adolescents. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about hemolytic uremic syndrome.
This Week in JAMA. JAMA. 2012;307(10):997. doi:10.1001/jama.2012.277