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This Week in JAMA
May 6, 2009

This Week in JAMA

JAMA. 2009;301(17):1737. doi:10.1001/jama.2009.622

To assess whether a program that offered case management and housing to chronically ill homeless adults would reduce their need for medical services, Sadowski and colleagues Article randomly assigned hospitalized homeless adults with chronic medical illnesses to receive transitional (respite care) housing after hospital discharge followed by placement in long-term housing and on-site case management or to receive usual hospital discharge planning services. In analyses that adjusted for demographic factors, prior health care utilization, and measures of health status at baseline, the authors found that compared with usual care, providing housing and case management to homeless adults with chronic medical illnesses resulted in fewer hospitalizations, hospital days, and emergency department visits during an 18-month follow-up. In an editorial, Kertesz and Weiner Article discuss the results of Housing First programs and the challenge of determining the subgroups of the homeless population who are likely to achieve the greatest benefit.

The incidence of and outcomes associated with ventricular tachycardia or fibrillation (VT/VF) among patients with ST-elevation myocardial infarction (STEMI) who are undergoing primary percutaneous coronary intervention (PCI) are not well understood. Mehta and colleagues analyzed data from 5745 STEMI patients who were undergoing primary PCI and found that sustained VT/VF occurred in 329 patients (5.7%). The authors also found that patients who experienced VT/VF before or after the end of cardiac catheterization had a significantly higher risk of 90-day mortality.

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Microalbuminuria, which is considered to be a marker of generalized endothelial dysfunction, is an acknowledged risk factor for arterial thromboembolism. To assess whether microalbuminuria is associated with venous thromboembolism (ie, deep vein thrombosis, pulmonary embolism, or both), Mahmoodi and colleagues analyzed data on urinary albumin excretion and risk factors for cardiovascular and renal disease from 8574 adults aged 28 to 75 years who were participants in the population-based, prospective Prevention of Renal and Vascular End-stage Disease study. The authors found that microalbuminuria was an independent risk factor for venous thromboembolism.

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Mrs D is a 51-year-old woman with a 5-day history of rhinorrhea, facial pressure, and tooth pain, who presents to her physician with a request for antibiotics to treat a “sinus infection.” In a discussion of this case, Hwang reviews evidence-based clinical practice guidelines for the diagnosis and treatment of acute viral and bacterial rhinosinusitis. He discusses aspects of the patient history that are considered “cardinal symptoms” of acute rhinosinusitis, the timing and use of antibiotic and adjunctive therapies, and indications for radiologic studies or endoscopy.

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“[Dawn] looked up and began to speak in short gasps. She wanted to go home. She wanted the central venous catheter removed. She was not interested in further transfusions or antibiotics.” From “Giving Up.”

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A new guideline recommends offering finasteride to asymptomatic men being screened for prostate cancer to reduce their risk for developing the disease, even though the drug does not lower mortality rates.

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The social face of economic growth: China's health system in transition

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Employment and US health care reform

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Incremental health care reform

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Health care reform: beyond ideology

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A comparison of results of meta-analyses of randomized clinical trials and recommendations of clinical experts

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Join Lisa A. Cooper, MD, MPH, from 2 to 3 PM eastern time on May 20 to discuss treatment adherence and hypertension control. To register, go to http://www.ihi.org/AuthorintheRoom.

For your patients: Information about acute sinusitis.

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