Extending their earlier work, Naylor and colleaguesArticle examined the
effectiveness of comprehensive discharge planning and home care by
advanced practice nurses for elderly patients at high risk of poor
outcomes after hospital discharge. Patients in the intervention group
were much less likely to be rehospitalized during the 6-month study
follow-up and had a longer time to first readmission than patients who
received routine discharge planning and home care. In an editorial,
BolingArticle highlights essential features of postacute care management.
In this retrospective medical record review, Jenny and colleaguesArticle found
that physicians initially failed to recognize 54 (31.2%) of 173 cases
of abusive head trauma in children younger than 3 years. Compared with
children in whom abusive head trauma was recognized, children in whom
the diagnosis was missed were younger and more were white, from intact
families, and presented with milder, nonspecific symptoms. Reinjury and
medical complications were attributed to the delay in diagnosis in
27.8% and 40.7% of missed cases of abusive head trauma, respectively.
In an editorial, LeventhalArticle identifies factors that interfere with
diagnostic reasoning and impair recognition of child abuse.
O'Connor and coworkers studied the use of 7 therapies, identified by
expert consensus as quality indicators for the treatment of acute
myocardial infarction (MI), in Medicare beneficiaries hospitalized with
first MI. Marked geographic variation in use of most of the
therapies was observed. For example, the rate of reperfusion using
thrombolytic therapy or coronary angioplasty ranged from 33.0% to
93.3% of patients determined to be ideal candidates for this treatment
Pulse pressure, the difference between systolic blood pressure and
diastolic blood pressure, increases with age as a result of arterial
stiffening. Chae and colleagues report that pulse pressure was an
independent predictor of congestive heart failure (CHF) in a cohort of
1621 community-based elderly individuals followed up prospectively for
almost 4 years. The risk of congestive heart failure among patients in
the highest tertile of pulse pressure was 55% higher than the risk in
the lowest tertile.
In primary cutaneous melanoma, thinner lesions are associated with
better patient survival. Epstein and colleagues interviewed patients
with newly detected melanoma to determine who first detected the lesion
and to investigate the relationship between patterns of detection and
tumor thickness. Lesions detected by physicians were thinner than those
detected by patients or other nonphysicians, and physician-detected
lesions were more likely to undergo biopsy within a month of detection.
Web resources for surgical information.
The first doctoral program of its kind, at the University of Illinois
at Chicago, teaches physicians how to treat disabled people and about
the emerging culture of disability.
Analysis of variable and fixed costs of a large urban teaching hospital
and implications for cost-saving strategies.
Hypertrophic cardiomyopathy mortality rates reported by tertiary
referral centers may overestimate the true mortality risk associated
with this disease.
How to provide high-quality service in health care: lessons from other
For your patients: A primer on skin cancer.
This Week in JAMA. JAMA. 1999;281(7):589. doi:10.1001/jama.281.7.589